Endocrine Abstracts (2006) 11 P457

Difficulties in diagnosing persistent acromegaly using current consensus criteria for cure after transsphenoidal surgery

M Petakov1, M Djurovic1, S Ognjanovic1, DJ Macut1, T Isailovic1, B Popovic1, I Bozic1, M Joksimovic2 & S Damjanovic1

1Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia and Montenegro; 2Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia and Montenegro.

Criteria to define biochemical remission of acromegaly following surgery have changed over the years, but still the controversy about current consensus exists. We assessed seventy newly diagnosed patients with acromegaly (43 females and 27 males, mean age 46.9±1.4 years, range 17–66 yrs) 8 weeks after transsphenoidal pituitary adenomectomy done by the same neursurgeon. Current consensus criteria were used to define postoperative remission: glucose-suppressed (nadir) GH less then 1.0 μg/l, and a normal sex- and age-adjusted IGF-I level. GH was assayed by fluoroimmunoassay, and IGF-I by radioimmunoassay. The short-term remission rates in 70 patients as determined by nadir GH, and IGF-I level were 64%, and 56% respectively. The discrepancy was due to a group of patients (No=6) with discrepant remission criteria who, despite adequate suppression of GH after glucose administration, i.e. the postglucose GH nadir less than 1 μg/l, had repetitively elevated IGF-I.

In conclusion, transsphenoidal adenomectomy is effective and safe initial, and often definitive, treatment for the majority of patients with acromegaly, especially when done by experienced neurosurgeon. Normalization of the IGF-I level seem to be the principal criteria for documenting biochemical remission in acromegaly, because post-glucose nadir GH as measured by fluoroimmunoassay could be misleading. The discrepancies between different consensus criteria confirm the need for their critical reevaluation and further refinement and standardization.

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