S. Valdemarsson et al., Early postoperative growth hormone levels: high predictive value for long-term outcome after surgery for acromegaly, J INTERN M, 247(6), 2000, pp. 640-650
Citations number
37
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Objectives. To explore the prognostic value of early - within 1 week - post
operative growth hormone (GH) measurements with regard to outcome after sur
gery for acromegaly in a short- and a long-term perspective.
Design. Retrospective study of patients operated on between 1987 and 1998,
including follow-up for up to 60 months.
Setting. University hospital.
Subjects. Sixty-eight patients with acromegaly.
Intervention. Pituitary surgery aiming at adenomectomy with preservation of
pituitary function.
Main outcome measures. The effect of the operation was evaluated after 3 mo
nths, mostly by means of an oral glucose load or by insulin-like growth fac
tor 1 (IGF-1). The specificity, sensitivity and the predictive values of an
early postoperative mean GH concentration less than or equal to 4.8 mU L-1
, as well as of the GH response to thyrotropin-releasing hormone (TRH) 3 mo
nths after surgery, were calculated with regard to outcome of the operation
in both 3-month and long-term perspectives.
Results. Fifty patients (73.5%) showed a satisfactory effect at the evaluat
ion 3 months postoperatively; 45 of these were followed between 12 and 60 m
onths. Relapse was registered in five cases: 12, 12, 24, 24 and 48 months a
fter surgery.
In the long-term perspective, the predictive value of an early mean GH less
than or equal to 4.8 mU L-1 was 93.6% with regard to a satisfactory effect
of surgery, compared with 90.2% for a normalized somatomedin C (SmC)/IGF-1
and 90.0% for an absent GH response after TRH. An early mean GH > 4.8 mU L
-1 had a 77.8% predictive value for persistent or recurrent disease, compar
ed with 85.7% for persistently increased SmC/IGF-1 and 68.8% for an abnorma
l GH release after TRH 3 months after surgery.
In the short-term perspective, the specificity and the predictive value of
an early GH less than or equal to 4.8 mU L-1 were 77.3 and 97.1%, respectiv
ely. Early GH > 4.8 mU L-1 had a 94.4% sensitivity but a predicative value
of only 63.0% for an unsatisfactory effect.
Conclusion. Measurement of GH within 1 week after surgery is highly predict
ive for outcome of surgery for acromegaly. Specifically, an early mean GH l
ess than or equal to 4.8 mU L-1 is as predictive for a satisfactory effect
of treatment as a normalized IGF-1 3 months after surgery. Early postoperat
ive GH values > 4.8 mU L-1 have a high sensitivity for persistent or recurr
ent disease in both the short- and long-term perspectives, but lower predic
tive value. The usefulness of the TRH test can be questioned.