Reoperation for growth hormone–secreting pituitary adenomas: report on an endonasal endoscopic series with a systematic review and meta-analysis of the literature (original) (raw)
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2016
Background & Aim: Transsphenoidal surgery in the setting of acromegaly is quite challenging due to the enlarged soft tissue mass, bony overgrowth, and bleeding. Since the 1990s, endoscopic transsphenoidal surgery for pituitary adenomas has increased in popularity. In this retrospective study, we reviewed our experience with endoscopic endonasal approach (EEA) in biochemical remission rates using the 2010 consensus criteria. Methods & Materials/Patients: The authors retrospectively analyzed data from 49 consecutive patients with acromegaly who underwent pure EEA. The criteria of biochemical remission were GH levels ≤ 1 ng/mL randomly, ≤ 0.4 ng/mL after oral glucose tolerance test and normal IGF-I levels for age and sex at least 3 months after surgery. Also, demonstration of the total removal of the tumor on MRI studies obtained after administration of contrast material at the 3-month postoperative follow-up visit. There was no noticeable residual tumor mass even in patients without r...
Arquivos de neuro-psiquiatria, 2017
The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensio...
World Neurosurgery, 2018
BACKGROUND: The endoscopic endonasal approach has recently become an acceptable option for resection of all pituitary adenomas. We assessed biochemical outcome of endoscopic endonasal surgery in growth hormone (GH)e secreting adenomas, including remission rate, predictors of remission, and associated complications.-METHODS: Sixty-eight consecutive patients with acromegaly who underwent endoscopic endonasal surgery were analyzed prospectively. Tumors were classified according to size, Knosp grade, and Hardy-Wilson classification. Biochemical remission was defined as normal serum insulin-like growth factor 1 level and either a suppressed GH serum level less than 0.4 mg/L during an oral glucose tolerance test or a random GH level less than 1.0 mg/L at least 3 months after surgery.-RESULTS: Total biochemical remission rate was 64.7%. Gross total resection was achieved in 61 of the 68 patients (89.7%). Remission was achieved in 12 of 16 microadenomas (75%) and 32 of 52 macroadenomas (61.5%). Based on univariate logistic regression analysis, preoperative variables predictive of remission were age (P [ 0.004), Knosp grade (P [ 0.023), and preoperative GH levels (P [ 0.042). Three patients (4.4%) experienced postoperative panhypopituitarism, and permanent diabetes insipidus was seen in 4 patients (5.9%). Two patients (2.9%) developed cerebrospinal fluid leaks, which were treated by lumbar puncture in one case and early surgical repair in the other case.-CONCLUSIONS: Endoscopic endonasal adenoma resection leads to a high rate of endocrinologic remission in GHsecreting adenomas with a low complication rate. Patients with older age, higher preoperative GH levels, and higher Knosp grades are less likely to achieve remission.
Archives of Neuroscience
Background: Nowadays, the endoscopic transsphenoidal approach is the initial option for resection of all pituitary adenomas. The current study reported the experience with endoscopic transsphenoidal surgery remission rates using the 2010 consensus criteria, predictors of remission, and the associated complications. Methods: A prospectively collected database of 49 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery was analyzed. Tumors were classified according to size, as well as the Knosp and the Hardy-Wilson classifications. Endocrinological remission was defined as normal insulin-like growth factor (IGF)-I level and either a suppressed growth hormone (GH) level < 0.4 ng/mL during an oral glucose tolerance test, or a random GH level < 1.0 ng/mL at least 3 months after the surgery. The extent of resection was evaluated on postoperative contrast-enhanced magnetic resonance imaging (MRI). Results: Biochemical remission was achieved in 7 of 9 (77.8%) microadenoma and 28 of 40 (70%) macroadenoma. The total remission rate was 71.4% and gross total resection was achieved in 45 of 49 (91.8%) patients. Tumor size, age, gender, history of prior surgery, suprasellar extension, and sphenoid sinus invasion were not associated with remission rate. Preoperative variables predictive of remission included the Knosp score (P = 0.041) and GH levels (P = 0.047). Two patients (4.1%) experienced postoperative pan hypopituitarism, and permanent DI was observed in 3 (6.1%) patients. One patient (2%) had cerebrospinal fluid (CSF) leaks treated with serial lumbar punctures. The median follow-up period was 25.45 months; ranged from 3 to 49. Conclusions: Endoscopic transsphenoidal adenoma resection leads to a high rate of endocrinological remission in patients with low acromegaly complication. Patients with high preoperative GH levels and the Knosp scores are less likely to achieve remission.
Journal of Neurosurgery, 1993
✓ The results of transsphenoidal adenomectomy for growth hormone (GH)-secreting pituitary adenomas in acromegaly performed over a 17-year period were analyzed retrospectively to determine which preoperative factors significantly influenced the long-term surgical outcome. These variables were then used to develop a logistic regression model to determine the probability of surgical failure. The series consisted of 103 patients. Long-term follow-up study (mean duration 102 ± 64 months) was performed to derive outcome analysis and determinants of failure. Surgical control was defined as a long-term postoperative serum basal GH level of less than 5 µg/liter, a long-term postoperative serum somatomedin C (SM-C) level of less than 2.2 U/ml, and a favorable clinical response. Eighteen (17.5%) patients did not meet these criteria. The overall control rate by the GH criteria was 81.3% and by the SM-C criteria 76.2%. By multivariate logistic regression analysis, tumor stage was the strongest p...
Clinical Endocrinology, 1998
OBJECTIVE Acromegaly is associated with reduced life expectancy, while therapeutic 'cure' (defined by achievement of GH levels <5 mU/l) is associated with normalization of life expectancy. Surgery remains the treatment of choice but in those in whom operative 'cure' is not achieved, radiotherapy and/or medical treatment are valuable treatment modalities. The chance of subsequent 'cure' with radiotherapy or somatostatin analogue therapy is increased if the post-operative GH level is reduced below 30 mU/l. Using strict criteria for cure and a single dedicated pituitary surgeon, two large European studies reported 'cure' rates of 42% and 56%. In the Manchester region, surgery for these patients has been performed by a number of neurosurgeons, with no specific designated pituitary surgeon dominating the picture. We wished to examine the impact of this surgical strategy on cure rates and the incidence of a post-operative GH level below 30 mU/l. DESIGN We reviewed the GH results between 1974 and 1997 for every acromegalic who had been referred to the endocrine departments of the two Manchester hospitals responsible for the majority of pituitary disease referrals in Manchester and who had been subsequently referred for pituitary surgery. PATIENTS AND MEASUREMENTS Seventy-three (33 male) patients had had GH status assessed before and after surgery by an OGTT or GH profile. The
Endoscopic Endonasal Transsphenoidal Approach for Growth Hormone Secreting Pituitary Adenoma
Al-Azhar International Medical Journal
Background: The use of endoscopic endonasal trans-sphenoid surgery (EETS) as the first-line therapy for most pituitary adenomas is gaining popularity. Aim of the work: The primary goal of this research was to see how transsphenoidal endoscopic technique for a growth hormone-secreting pituitary adenoma affected hormonal reduction in relation to surgical excision extent. Patients and Methods: This prospective research was carried out at the Al Azhar University Hospitals' neurosurgery department (Al-Hussein and Bab El-Shaeria). This study was conducted on 15 cases with Growth hormone secreting pituitary adenoma that had undergone total or subtotal resection performed by endoscopic endonasal transsphenoidal surgery. Result: there was highly statistically substantial (p-value < 0.001) decreased post-operative growth hormone (3.4 ± 1.2) when compared with pre-operative growth hormone (38.1 ± 29.8). Highly statistically significant (p-value < 0.001) decreased post-operative IGF-1 (242.3 ± 102.1) when compared with pre-operative IGF-1 (665 ± 253). No statistically significant difference (p-value > 0.05) between pre-operative and post-operative the following hormones (ACTH, cortisol, T3, T4, TSH, testosterone, FSH, LH and PRL, estradiol). Conclusion: In individuals with acromegaly, the endoscopic endonasal transsphenoidal technique is an efficacious and secure treatment for adenomas. We discovered that using an endoscopic endonasal transsphenoidal technique reduced growth hormone and insulin-like growth factor-1 levels considerably.
BMC Endocrine Disorders, 2021
Background Regarding the inconclusive results of previous investigations, this study aimed to determine the association between pathology, as a possible predictor, with remission outcomes, to know the role of pathology in the personalized decision making in acromegaly patients. Methods A retrospective cohort study was performed on the consecutive surgeries for growth hormone (GH) producing pituitary adenomas from February 2015 to January 2021. Seventy-one patients were assessed for granulation patterns and prolactin co-expression as dual staining adenomas. The role of pathology and some other predictors on surgical remission was evaluated using logistic regression models. Results Among 71 included patients, 34 (47.9%) patients had densely granulated (DG), 14 (19.7%) had sparsely granulated (SG), 23 (32.4%) had dual staining pituitary adenomas. The remission rate was about 62.5% in the patients with SG and DG adenomas named single staining and 52.2% in dual staining groups. Postopera...
Outcomes of Transsphenoidal Surgery in Growth Hormone-Secreting Pituitary Adenomas
Indian Journal of Neurosurgery
Growth hormone (GH)-secreting pituitary adenomas (PA) make up 15 to 20% of total amount of hormonally active adenomas. In addition to acromegaly and gigantism, these tumors cause deep metabolic disturbances. Its systemic impact leads to increased mortality ratio of 1.32 compared with general population. Surgical removal remains the priority treatment option in controlling acromegaly and provides endocrinologic remission in up to 72% patients. A total of 92 patients were included in the study. All surgeries were performed via microscopic transsphenoidal approach (TSA) by the senior author in our institution between December 2009 and October 2019. Only patients who were followed-up with 75 g oral glucose tolerance tests (OGTTs), GH, and insulin-like growth factor I (IFG-I) measurements preoperatively, 1 week, and every 6 months postoperatively were analyzed. Based on standard preoperative 1.5-T MR imaging with contrast enhancement, the adenomas were identified and distributed accordin...