Endocrine Abstracts

Aim of the study: To assess the efficacy of endoscopic transsphenoidal surgery (ETS) in acromegalic patients.

Methods: Over the past 13 years, 207 consecutive patients (117 females; median age, 46 years, range 14–78) affected with GH-secreting adenoma (79 microadenomas, 38%) were operated on in our centre by the same surgical team. Age, gender, tumor size, extension, invasiveness of surrounding structures, and histopathologic features (ki67, mitoses, hystotype) have been considered together with preoperative clinical history and postoperative follow-up. An early postoperative assessment was carried out 3–6 months after surgery. The follow-up period ranged from 3 to 160 months. A statistical analysis was performed to assess a correlation with poor outcome.

Results: In the early postoperative assessment, biochemical control rate with normalization of IGF1 was 72%. Control rate remained the same during the follow-up. After surgical debulking, pharmacological treatment (somatostatin analogues and/or pegvisomant) further increased the control rate, which achieved 97%. The remaining 3% of patients still remains uncontrolled after surgery and complementary treatments (pharmacological therapy and/or radiotherapy). No mortality was observed. Diabetes insipidus (DI) and pituitary insufficiency (three and four cases, respectively) accounted for permanent postoperative morbidity. Transient morbidity encompassed transient DI (13 cases), symptomatic SIADH (seven cases), epistaxis (two cases), and CSF leak requiring intervention (one case). Both invasiveness and previous surgery correlated with unfavorable outcomes (P<0.01, χ² test). In the multi-variate analysis, only invasiveness of the cavernous sinus and/or the surrounding bone structures was related with worse results (P<0.01).

Conclusion: Our data confirm that ETS performed by dedicated and experienced surgeons is the treatment of choice for acromegaly. Invasiveness was the main factor responsible for poor outcome. Control rate further improved by pharmacological treatments in patients with surgical debulking of the tumor, while a low percentage (3%) did not respond satisfactorily to any treatment.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.