Endocrine Abstracts (2013) 32 P924 | DOI: 10.1530/endoabs.32.P924

Endoscopic transsphenoidal surgery for acromegaly: assessing the surgical outcome based on current criteria of remission

Grzegorz Zielinski1, Przemyslaw Witek2 & Jan Podgorski1

1Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland; 2Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland.

Introduction: Acromegaly is associated with increased morbidity and mortality, mainly due to cardiovascular and metabolic complications and higher risk of malignancy. The treatment of choice is selective transsphenoidal surgery (TSS). Successful removal of somatotroph adenoma normalizes GH and IGF1 levels, which improves the patients prognosis. The efficacy of TSS depends on the tumor volume, parasellar extension and surgeon experience.

The aim of this study was to assess the safety and efficacy of pure, endoscopic TSS based on the stringent criteria of remission.

Material and methods: Retrospective study involving 25 consecutive patients with GH-secreting pituitary adenoma (9 males and 16 females). The mean age was 45.04 years. All subjects underwent pure endoscopic TSS in 2010. They were all operated on by the same neurosurgeon and according to the same surgical protocol. Diagnosis of acromegaly was based on commonly adopted hormonal criteria and magnetic resonance imaging (MRI). Lateral invasion to the cavernous sinuses was classified according to Knosp’s scale. Remission was defined as nadir GH ≤0.4 ng/ml following 75.0 of oral glucose and IGF1 within the referral limits for age and gender or random GH ≤1 ng/ml.

Results: The MRI precisely visualized 18 macroadenomas (72%) and 7 microadenomas (28%) in the study group. Remission was achieved in 11 subjects with macroadenomas (61.1%) and in six patients with microadenomas (85.7%). Intraoperative, cerebrospinal fluid leakage was observed in six subjects with pituitary macroadenoma. Additionally, one case of epistaxis and one sinusitis was found. There were neither meningitis nor persistent CSF leakage. The permanent diabetes insipidus and anterior pituitary insufficiency was observed in case of one patient.

Conclusions: Pure endoscopic TSS was an effective and safe procedure. The main limitation of complete tumor removal was cavernous sinuses involvement.

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