RETROSPECTIVE ANALYSIS OF LONG-TERM SURGICAL RESULTS IN ACROMEGALY - PREOPERATIVE AND POSTOPERATIVE FACTORS PREDICTING OUTCOME

OBJECTIVE Sixty-one of 83 patients with acromegaly treated between 196 9 and 1993 were analysed retrospectively to clarify which early postop erative factors were significant predictors of a successful long-term outcome and which preoperative factors significantly influenced the ea rly postoperative results, PATIENTS Of the 61 patients, 30 were operat ed on before 1987 and 31 afterwards, A successful long-term surgical o utcome was defined as a long-term mean basal GH level < 6 mU/l (compar able to < 3 mu g/l), a normal IGF-I level, and normal GH dynamics, RES ULTS Overall, 59% of patients (37% before 1987 and 81% after) had an e arly postoperative mean basal GH level < 6 mU/l, and 56% (29% before 1 987 and 77% after) met all three of the specified criteria for a succe ssful longterm surgical outcome. Statistical analysis confirmed that G H dynamics and postoperative mean basal GH level < 6 mU/l were signifi cant predictors of the long-term surgical outcome, whereas the postope rative IGF-I level alone was not. On the other hand, abnormal preopera tive GH dynamics were normalized in all patients with a postoperative mean basal level < 6 mull. In addition, there were no patients showing an unsuccessful longterm outcome in those associated with both the ea rly postoperative mean basal GH level < 6 mull and normalization of th e IGF-I level. Therefore, measurement of the early postoperative mean basal On level and the IGF-I level may be an economical and simple gui de to predict the long-term surgical outcome, Moreover, multivariate a nalysis indicated that cavernous sinus invasion was an independent sig nificant factor influencing the early postoperative outcome, CONCLUSIO NS Successful long-term surgical outcome may be predicted if early pos toperative mean basal GH level is reduced to < 6 mU/l (< 3 mu g/l) and IGF-I level becomes normal, This study also confirms that early diagn osis and treatment by an experienced endocrinologist and neurosurgeon can improve the operative results in patients with acromegaly.