Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

ABSTRACT Objective The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods 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. Results 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. Conclusion 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 extensions may preclude gross total resection of these tumors.

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Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors

Neurosurgery ◽

10.1093/neuros/nyx020 ◽

2017 ◽

Vol 81 (2) ◽

pp. 357-366 ◽

Cited By ~ 22

Author(s):

Harish Babu ◽

Alicia Ortega ◽

Miriam Nuno ◽

Aaron Dehghan ◽

Aaron Schweitzer ◽

...

Keyword(s):

Cavernous Sinus ◽

Transsphenoidal Surgery ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Endoscopic Transsphenoidal Surgery ◽

Cavernous Sinus Invasion ◽

Remission Rates

Abstract BACKGROUND: Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented. OBJECTIVE: To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness. METHODS: We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center. Hormonal remission was established by normal insulin-like growth factor (IGF)-1, basal serum growth hormone <2.5 ng/mL, and growth hormone suppression to <1 ng/mL following oral glucose tolerance test. Oral glucose tolerance test was performed at 3 months after surgery, and then as indicated. IGF-1 was measured at 3 months and then at least annually. We evaluated tumor granularity, nuclear expression of p21, Ki67 index, and extent of cavernous sinus invasion, and correlated these with remission status. RESULTS: Fifty-eight patients that underwent surgery had follow-up from 38 to 98 months (mean 64 ± 32.2 months). There were 21 microadenomas and 37 macroadenomas. Three months after surgery 40 of 58 patients (69%) were in biochemical remission. Four additional patients were in remission at 6 months after surgery, and 1 patient had recurrence within the first year after surgery. At last follow-up, 43 of 44 (74.1%) of patients remained in remission. Cavernous sinus invasion by tumor predicted failure to achieve remission. CONCLUSIONS: Prognostic markers of disease aggressiveness other than cavernous sinus invasion did not correlate with surgical outcome. Long-term remission after surgery alone was achieved in 74% of patients, indicating long-term efficacy of endoscopic surgery.

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Endoscopic endonasal lateral transellar approach for growth hormone-secreting adenomas with cavernous sinus invasion: Technical note and surgical results

Neurocirugía (English Edition) ◽

10.1016/j.neucie.2020.05.002 ◽

2021 ◽

Vol 32 (4) ◽

pp. 170-177

Author(s):

Juan Luis Gómez-Amador ◽

Jaime Jesús Martínez-Anda ◽

Pablo David Guerrero-Suarez ◽

Arturo Miguel Rosales-Amaya ◽

Julio Cesar Delgado-Arce ◽

...

Keyword(s):

Growth Hormone ◽

Cavernous Sinus ◽

Technical Note ◽

Surgical Results ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Growth Hormone Secreting Adenomas

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Association of different pathologic subtypes of growth hormone producing pituitary adenoma and remission in acromegaly patients: a retrospective cohort study

BMC Endocrine Disorders ◽

10.1186/s12902-021-00850-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maryam Dehghani ◽

Zahra Davoodi ◽

Farahnaz Bidari ◽

Amin Momeni Moghaddam ◽

Davood Khalili ◽

...

Keyword(s):

Growth Hormone ◽

Cohort Study ◽

Cavernous Sinus ◽

Retrospective Cohort Study ◽

Pituitary Adenomas ◽

Retrospective Cohort ◽

Remission Rate ◽

Cavernous Sinus Invasion ◽

Dual Staining

Abstract 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. Postoperative remission was 1.53-folds higher in the single staining adenomas than dual staining-one (non-significant). The remission rate was doubled in DG group compared to two other groups (non-significant). By adjusting different predictors, cavernous sinus invasion and one-day postoperative GH levels decreased remission rate by 91% (95% CI: 0.01–0.67; p = 0.015) and 64% (95% CI: 0.19–0.69; p < 0.001), respectively. Responses to the medications were not significantly different among three groups. Conclusion Various pathological subtypes of pituitary adenomas do not appear to have a predictive role in estimating remission outcomes. Cavernous sinus invasion followed by one-day postoperative GH is the strongest parameter to predict biochemical remission.

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