Outcome of surgery for acromegaly - the experience of a dedicated pituitary surgeon

Previous large series of outcome following pituitary surgery for acromegaly , including our own, have demonstrated poor results, with cure, defined as CH <5 mU/l, achieved in only 33-42% of patients. In our previous series, su rgery was performed by one of eight different surgeons. Largely based on th e disappointing results of this previous audit of outcome, our practice sin ce 1990 has been, whenever possible, to refer all patients with acromegaly to a dedicated pituitary surgeon (APJ). The objective of the current study was to re-analyse the outcome of surgical treatment for acromegaly since in stituting this change. Tumour size and extension was determined on CT/MRI s canning. Biochemical cure was defined as a basal GH <5 mU/I or a nadir GH o f <2 mU/I across an OGTT following initial pituitary surgery. Surgery was p erformed on 66 patients and 42 (64%) were cured, compared with 26/78 (33%) in our previous study (p < 0.0005, chi(2) test). The cure rate for microade nomas (n=22) was 86%, and for macroadenomas 52%, compared with 54% (p<0.05, chi(2) test) and 30% (p<0.05, chi(2) test) respectively, in our previous s tudy. We conclude that surgical outcome for acromegaly is enhanced if patie nts are operated on by a single experienced surgeon.