Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2011) 26 P256

ECE2011 Poster Presentations Pituitary (111 abstracts)

Low incidence of adrenal insufficiency after transsphenoidal surgery in patients with acromegaly: a long-term follow-up study

A M G Burgers , N E Kokshoorn , A M Pereira , F Roelfsema , J W A Smit , N R Biermasz & J A Romijn


Leiden University Medical Center, Leiden, The Netherlands.


Background: The long-term prevalence of adrenal insufficiency after transsphenoidal surgery for GH secreting pituitary adenomas was unknown. However, recently a single study reported a high prevalence of adrenal insufficiency after surgical and/or medical treatment without postoperative radiotherapy in acromegalic patients.

Aim: To assess the prevalence and incidence rate of adrenal insufficiency in consecutive patients during long-term follow-up after successful transsphenoidal surgery for acromegaly.

Methods: In 91 consecutive patients in remission after transsphenoidal surgery, we retrospectively reviewed insulin tolerance tests, CRH stimulation tests, metyrapone tests and ACTH stimulation tests used to assess corticotrope function.

Results: Early postoperatively, insufficient adrenal function was observed in 18% of patient (n=16), which was transient in 8 and irreversible in 8 other patients in the first year of postoperative follow-up. Therefore, after the first year, the prevalence of adrenal insufficiency was 9%. Late, new-onset adrenal insufficiency developed in only 3 patients, 13, 18 and 24 years postoperatively, resp. The incidence rate of late adrenal insufficiency after successful surgery was 2/1000 person years.

After long-term follow-up, with a mean duration of 17.7±8.1 years, the prevalence of secondary adrenal insufficiency was 12% in patients in remission after surgery for acromegaly.

Conclusion: The prevalence of adrenal insufficiency 1 year after surgery was 9%, whereas during prolonged follow-up the incidence rate of adrenal insufficiency was only 2/1000 person years in patients in remission after surgery. Therefore, development of late onset adrenal insufficiency is a very infrequent complication in patients with acromegaly in remission after transsphenoidal surgery only.

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