Acromegaly is associated with increased morbidity and mortality. Surgical excision of the adenoma remains the best option to attain a cure. The results of surgery in the region were unsatisfactory compared to other European centres as was amply borne out in a 1998 review. As the lack of a dedicated pituitary surgical team was considered contributory, one was developed offering Endoscopic, transsphenoidal, pituitary surgery and their results audited.
Sixteen consecutive Acromegalics with radiologically confirmed adenomas underwent endoscopic surgery in 2005/6. On post-operative day three and four a GH day curve and an OGTT with GH were performed. Patients were considered cured if the mean GH on day curve was <5 mU/l and the nadir on OGTT< 2 mU/l. If not cured in these tests, a re-operation within the first week and retesting was offered. Those with borderline results (raised by 1 mU/l from the cutoff values) were kept under review without re-operation. Cure was reconfirmed and other pituitary functions were reassessed at least 6 weeks after operation.
8 of 16 (50%) were biochemically cured after the first operation. Four (25%) had borderline results of whom 3 were biochemically cured at 6 weeks. The remaining four (25%) underwent an immediate redo-operation resulting in biochemical cure in two. A total cure rate of 81.25% was attained. This is a significant improvement over our previous rate of 17.8% and compares well with the European rates. The mean hospitalisation was 8.5±5.2 days. Apart from minor bleeding in three, no major vascular injuries were noted. Postoperative CSF leak was seen in one and self limiting DI in 5 patients with one requiring DDAVP on discharge. No cases of meningitis and two with sinusitis were identified.
The development of a dedicated pituitary service has resulted in a significant improvement in cure rates with low postoperative complications.