Original ArticleEndoscopic Transsphenoidal Approach for Acromegaly with Remission Rates in 401 Patients: 2010 Consensus Criteria
Introduction
Acromegaly is a disease described by high levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1), mostly due to GH secretion by a pituitary adenoma.1 The clinical characteristics of acromegaly are related skeletal, tissue, and organ growth that leads to dysmorphic craniofacial features, musculoskeletal deformity, and cardiovascular, metabolic, and respiratory complications due to increased GH secretion.2, 3 Normalization of GH levels alleviates symptoms and reduces mortality rates to the levels found in the general population.2 The annual incidence of acromegaly is 5 cases per 1,000,000 individuals, and the treatment options are surgery, medical therapy, and radiotherapy.4 Transsphenoidal surgery is the first-choice treatment for acromegaly.5, 6, 7, 8, 9, 10, 11, 12, 13 At present, endoscopic transsphenoidal surgery is preferred because of the benefits of improved surgical visualization, less nasal trauma, enhanced patient comfort, and better results of tumor removal than transsphenoidal microsurgery.14, 15, 16 A published series described several factors as markers of remission, including preoperative mean GH and IGF-1 levels,5, 17 cavernous sinus invasion,5, 18 tumor size,19, 20, 21 extrapseudocapsular resection,22, 23 and experience of the surgeon.8 According to the 2010 consensus guidelines, remission is interpreted as IGF-1 levels normal for age and sex, and a postoperative random GH level of <1 ng/mL or GH level of <0.4 ng/mL after an oral glucose tolerance test.24 The reported rates of biochemical remission of acromegaly after surgery range from 34% to 83%.4, 16, 17, 25, 26, 27, 28
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Patients
A total of 401 consecutive patients underwent 432 endoscopic transsphenoidal surgeries between August 1997 and June 2016 at the Pituitary Research Centre of Kocaeli University, Kocaeli, Turkey. The medical records of 401 patients with GH-secreting adenomas were retrospectively reviewed. Informed consent was obtained from all patients, and the study was approved by the Ethical Committee of Kocaeli University, Turkey. Neurologic and endocrinologic assessments were performed before and after
Demographic Data, Symptoms, and Signs of the Patients
A total of 432 surgeries were performed for the 401 patients (2 surgeries for 23 patients, 3 for 4 patients). The patient cohort included 189 (47.1%) female patients and 212 (52.9%) male patients (mean age, 42.04 ± 11.7 years; median age, 41 years; age range, 11–71 years). The follow-up duration was 13 to 182 months (Table 1).
Signs and symptoms of acromegaly constituted the majority complaint of the patients. There were visual field abnormalities in 54 patients. Visual field findings of both
Discussion
Surgical intervention is recommended for the primary management of GH-secreting adenomas. Patients who do not experience remission with surgery often require adjuvant medical or radiation therapy.31 An endoscopic approach offers the advantages of improved surgical visualization, less nasal trauma, increased patient comfort, and better results of total tumor removal.17, 19, 21, 32
In the literature, reported remission rates range from 31.9% to 84.7% (Table 8).31, 32, 33, 34, 35, 36, 37, 38, 39, 40
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2020, Growth Hormone and IGF ResearchCitation Excerpt :Similarly, in the patients with initially larger adenomas, the frequency of recurrence after remission was also found to be increased. Contradictory results regarding the prognostic values of factors such as the patient's age, gender, cavernous sinus invasion, compression of optic chiasm, hypopituitarism, and IHC staining pattern of the adenoma have been reported in prior studies [12–27]. The present study found that the optic chiasm compression, but not the patient's age, gender, cavernous sinus invasion, hypopituitarism, or IHC staining pattern, was of prognostic value in relation to both remission and recurrence.
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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