Endocrine Abstracts

Background: Transsphenoidal adenomectomy is the first choice of therapy, but about 50% of patients are not cured and require medical treatment and/or radiotherapy. We retrospectively analyzed the data on surgery, sandostatin analog therapy, radiotherapy and the combination of them.

Materials-methods: The records of the 96 female and 70 male, totally 166 acromegalic patients who had been followed in Ankara University, Endocrinology and Metabolic Diseases Department from 1985 till now were documented. Collected data include estimated data of initial symptoms, date of diagnosis, results of pituitary imaging, the treatment modalities and the remission rates. Remission criteria was GH<1 with oral glucose tolerance test (OGTT) and IGF-1 normal with respect to age and gender.

Results: Macroadenomas were detected in 74% and microadenomas in 26% of the patients. In patients with macroadenoma median growth hormone (GH) was 19.4 ng/ml (1.6–236.8) and median IGF-1 was 1000 ng/ml (323–4500) while in patients with microadenoma median GH was 9.2 ng/ml (2.1–56) and median IGF-1 was 668.5 ng/ml (150–1801). The remission rate was 46% in microadenomas and 31% in macroadenomas giving a total rate of 35% after the first operation. When GH cut off was reduced to <0.4 the remission rate decreased to 23% in microadenomas, 17% in makroadenomas and 18% totally. Somatostatin analog (SSA) treatment was given to 46 patients after the surgery and remission was detected in 46% of the patients. Radiotherapy (RT) was applied to 31 patients (19 conventional RT, 12 gama-knife). Of 24 of them had also SSA treatment. When RT was applied alone after surgery remission rate was 11%, but if RT and SSA combination was given following surgery the remission rate increased to 50%.

Conclusion: Pituitary surgery is an effective treatment for lowering GH and IGF-1, but adjuvant therapy as SSA and/or RT are required to reach higher remission rates.