Introduction: Acromegaly is a chronic disorder usually caused by growth hormone (GH)-secreting pituitary adenomas. Transsphenoidal surgery remains a treatment of choice for restoring GH to normal levels. The aim of this study was to illustrate the relationship between some factors and transsphenoidal surgery outcomes.
Patients and methods: We retrospectively analysed the outcome of 31 patients with acromegaly after initial endoscopic transsphenoidal surgery in three university hospitals from 1988 until 2017. Laboratory values and tumor imaging data were collected pre and post-operatively. The criteria of biochemical remission were GH levels < 0.4 ng/ml after oral glucose tolerance test (OGTT) and normal IGFI levels for age and sex within the first 3 months after surgery.
Results: Median age of the 31 patients was 37 [13; 77] at the time of surgery, with a female/male ratio of 1.35. Microadenomas were found only in one patient (3.2%) and macroadenomas in 30 patients (96.7%). Three months after surgery, a radiological complete response at MRI was achieved in 10 patients (32%) but biochemical remission was obtained in only 5 patients (16%). Age at diagnosis, gender, preoperative IGF-1, random GH levels and nadir GH/OGTT were not predictive of poor outcomes. MRI-results: a radiological complete response was obtained in significantly smaller tumors compared with those with an incomplete resection (median diameter 17 vs 31 mm; P=0.02). Tumor diameter greater than 15 mm (P=0.03) and intracavernous extension (P=0.03) were significantly associated with a higher probability of incomplete tumor resection.
Conclusion: Intracavernous invasion and tumor size seem to be the strongest predictive surgical outcome parameters. Earlier detection of acromegaly would be the key to improve overall outcomes.
18 - 21 May 2019
European Society of Endocrinology