Endocrine Abstracts

JOINT1609

Introduction: Re-intervention, either repeat surgery or radiotherapy, is suggested in patients with acromegaly if primary transsphenoidal surgery does not lead to remission. However, the evidence for re-intervention is weak. Our aim was to assess efficacy and safety of re-intervention.

Methods: Patients diagnosed with acromegaly at Oslo University Hospital between 2005 and 2021, and with two or more interventions were included in the study cohort. Re-interventions included repeat surgery and/or radiotherapy after primary surgery. Remission was defined as IGF-1 below the upper limit of reference range without concurrent medical therapy. Adenoma size was classified as micro- (<1 cm) or macroadenoma (≥1 cm) and invasiveness after the Knosp-Steiner criteria. Assessed complications were pituitary deficiency, cerebrospinal fluid leakage, meningitis, vascular injury, postoperative hematoma and venous thromboembolism.

Results: Of 223 patients diagnosed with acromegaly, 42 patients were included in the study cohort. At baseline, median age was 38 (IQR 29-48) years, 41 had macroadenomas and one had a microadenoma. After re-intervention, 23 patients (55 %) were in remission and eleven patients (26%) could reduce the dosage of medical therapy (table 1). Seventeen were in remission after repeat surgery and six after radiotherapy. Of the 19 patients not in remission, seven had undergone surgery with the goal of debulking and thus not remission. After re-intervention, seven patients acquired new hormone deficiencies, five after repeat surgery and two after radiotherapy. Two patients acquired corticotroph deficiency, one after repeat surgery and one after radiotherapy. One patient had cerebrospinal fluid leakage and meningitis after repeat surgery; The patient recovered, and his acromegaly was in remission. There was no incidences vascular injury, postoperative hematoma or venous thromboembolism after repeat surgery.

Conclusion: In this single center study, re-intervention was safe and resulted in remission or substantial improvement in most patients. Re-intervention should be considered for patients who would otherwise require lifelong medical treatment.

Key words: acromegaly; re-intervention; somatotroph adenoma; transsphenoidal surgery; pituitary deficiency; radiotherapy; repeat surgery.