ECE2013 Poster Presentations Pituitary – Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (127 abstracts)
Diagnostic features and surgical therapy of acromegalic patients: experience of the last three decades
Emanuele Ferrante 1, , Elisa Sala 1, , Marco Locatelli 4 , Giovanna Mantovani 1, , Elena Malchiodi 1, , Giorgio Carrabba 4 , Sergio Maria Gaini 4 , Andrea Gerardo Lania 1, , Anna Spada 1, & Paolo Beck-Peccoz 1,
1Department of Medical Sciences, University of Milan, Milan, Italy; 2Endocrinology and Diabetology Unit, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 3Unit of Endocrinology, Istituto Clinico Humanitas Irccs, Rozzano, Italy; 4Neurosurgery Unit, Fondazione Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
Introduction: Acromegaly is a rare and insidious disease associated with an increased morbidity and mortality. Trans-sphenoidal (TNS) surgery remains the primary therapeutic option, in particular for intrasellar microadenomas and noninvasive macroadenomas. Aims of this study were to describe diagnostic features and to verify the impact of TNS surgery on treatment of acromegaly over three decades, before and after the identification of a dedicated neurosurgical team.
Design and methods: Forty-nine patients (group A) who underwent TNS surgery by a dedicated neurosurgical team between 2000 and 2010, and 126 patients (group B) who underwent TNS approach by a not selected operator between 1979 and 1999 were retrospectively analyzed.
Results: At baseline, 67% of patients of group A and 69% of patients of group B were macroadenomas. The mean delay of diagnosis was 5.5 and 5.9 years in group A and B, respectively. Moreover, no significant differences between two groups in terms of mean basal GH levels, mean GH nadir values, prevalence of hypopituitarism and hypertension were observed. IGF1 SDS were significantly higher, while BMI and prevalence of IGT/diabetes were significantly lower in group B than in group A. After surgery, overall remission rate was 53% in patients of group A (75% in microadenomas and 42% in macroadenomas, P<0.05) and 37% in patients of group B (P=0.08 vs group A; for microadenomas, 34 vs 75% of group A, P<0.05, for macroadenomas, 36 vs 42% of group A, P=NS).
Conclusions: Our data confirm that a dedicated neurosurgical team is needed in order to improve remission rates of surgery in acromegalic patients. However, we do not observe significant changes in biochemical, clinical and neuroradiological presentation of disease over the last three decades. As the high prevalence of macroadenomas negatively influence surgical cure, earlier diagnosis should be considered mandatory to achieve a better outcome.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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