J. Kreutzer et al., Surgical management of GH-secreting pituitary adenomas: An outcome study using modern remission criteria, J CLIN END, 86(9), 2001, pp. 4072-4077
The results of transsphenoidal surgery as initial therapy for GH-secreting
pituitary adenomas in 57 acromegalic patients were analyzed retrospectively
. Patients with prior surgery or radiation therapy were excluded from the s
tudy. Three different criteria were used to define remission: glucose-suppr
essed (nadir) GH less than 1.0 mug/liter, a normal sex- and age-adjusted IG
F-I level, and postoperative random GH levels of 2.5 mug/liter or less. Add
itionally, we analyzed the neuropathological data, including immunohistoche
mistry and ultrastructural categorization, and the surgical complications.
The short-term remission rate (6-wk postoperative follow-up visit), as dete
rmined by a random GH measurement of 2.5 mug/liter or less, was 48.8%; the
remission rate, as determined by nadir GH, was 51.4%. For 57 patients follo
wed for 12 months or more after surgery (mean, 37.7 months), surgical remis
sion was achieved in 70.2%, 66.7%, and 61.1%, respectively, for patients as
sessed by normal IGF-I, random GH, and nadir GH. One patient (1.1%) develop
ed recurrence of active acromegaly 81 months after initially successful sur
gical therapy. Extrasellar growth of the tumor (P = 0.04) and dural invasio
n by the adenoma (P = 0.008) were significant univariate predictors of a po
or outcome. Tumor size was significantly greater in patients with persisten
t or recurrent acromegaly (P = 0.02). Patients with tumors of the ultrastru
ctural categories of mixed GH/PRL cell and mammosomatotroph adenomas had th
e lowest remission rates (50% and 42.9%, respectively). There were no perio
perative deaths, and there was no serious morbidity. The permanent complica
tion rate was 3.3% (1 permanent DI and 2 nasal septal perforations). Surgic
al management of acromegaly currently provides prompt, effective, and satis
factory initial treatment for the majority of patients. Using stringent cri
teria for remission, primary transsphenoidal surgery for GH-secreting pitui
tary adenomas is effective and often definitive therapy for acromegaly. The
se results provide a benchmark for the contemporary results of surgical man
agement as assessed by modern outcome criteria.