Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

2010 ◽  
Vol 29 (4) ◽  
pp. E5 ◽  
Author(s):  
Peter G. Campbell ◽  
Erin Kenning ◽  
David W. Andrews ◽  
Sanjay Yadla ◽  
Marc Rosen ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenomas ◽  
Remission Rate ◽  
Csf Leak ◽  
Oral Glucose ◽  
Cure Rate ◽  
Cavernous Sinus Invasion ◽  
Remission Criteria ◽  
Biochemical Cure ◽  
Transsphenoidal Resection

Object Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)–secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. Methods A retrospective review of a prospectively maintained database was performed. The authors reviewed cases in which an endoscopic resection of GH-secreting pituitary adenomas was performed. The cohort consisted of 26 patients who had been followed for 3–60 months (mean 24.5 months). The thresholds of an age-appropriate, normalized insulin-like growth factor–I concentration, a nadir GH level after oral glucose load of less than 1.0 μg/l, and a random GH value of less than 2.5 μg/l were required to establish biochemical cure postoperatively. Results Overall, in 57.7% of patients undergoing a purely endoscopic transsphenoidal pituitary adenectomy for acromegaly, an endocrinological cure was achieved. The mean clinical follow-up duration was 24.5 months. In patients with microadenomas (4 cases) the cure rate was 75%, whereas in patients harboring macroadenomas (22 cases) the cure rate was 54.5%. Cavernous sinus invasion (Knosp Grades 3 and 4) was associated with a significantly lower remission rate (p = 0.0068). Hardy Grade 3 and 4 tumors were also less likely to achieve biochemical cure (p = 0.013). The overall complication rate was 11.5% including 2 incidents of transient diabetes insipidus and 1 postoperative CSF leak, which were treated nonoperatively. Conclusions A purely endoscopic transsphenoidal approach to GH-secreting pituitary adenomas leads to similar outcome for noninvasive macroadenomas compared with traditional microsurgical techniques. Furthermore, this approach may often provide maximal visualization of the tumor, the pituitary gland, and the surrounding neurovascular structures.

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

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.

scholarly journals The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’

2005 ◽  
Vol 152 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Panagiotis Nomikos ◽  
Michael Buchfelder ◽  
Rudolf Fahlbusch
Keyword(s):  
Transsphenoidal Surgery ◽  
Tumour Size ◽  
Secretory Activity ◽  
Primary Treatment ◽  
Oral Glucose ◽  
Consecutive Series ◽  
Primary Therapy ◽  
Cure Rate ◽  
Repeat Surgery ◽  
Biochemical Cure

Background and aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure. Method: We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used. Results: The rate of biochemical ‘cure’ correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively). Conclusions: These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.

THE DYNAMICS OF GROWTH HORMONE AND PROLACTIN SECRETION IN ACROMEGALIC PATIENTS WITH "MIXED" PITUITARY TUMOURS

1979 ◽  
Vol 90 (2) ◽  
pp. 198-210 ◽  
Author(s):  
Steven W. J. Lamberts ◽  
Jan G. M. Klijn ◽  
Giok H. Kwa ◽  
Jan C. Birkenhäger
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenomas ◽  
Suppressive Effect ◽  
Oral Glucose ◽  
Delayed Response ◽  
Thyrotrophin Releasing Hormone ◽  
Lowering Effect ◽  
Close Relationship ◽  
Plasma Gh ◽  
Plasma Prl

ABSTRACT The dynamics of growth hormone (GH) and prolactin (PRL) secretion in response to thyrotrophin-releasing hormone (TRH) and bromocriptine were evaluated in 15 untreated and 1 previously unsuccessfully treated patients with acromegaly. In 7 of these patients elevated basal PRL levels were found. In 4 of the 7 hyperprolactinaemic patients plasma PRL concentrations followed closely the pattern of GH secretion in response to TRH (400 μg). The maximal paradoxical increment of GH in response to TRH was paralleled by a delayed PRL response, while a close relationship was observed between the suppression of the elevated GH and PRL levels in these patients after one single dose of 2.5 mg bromocriptine. In one of these patients parallel escapes of plasma GH and PRL during bromocriptine treatment were seen. In addition, a significant higher sensitivity to the GH-lowering effect of 2.5 mg bromocriptine was noted from 2 up to 8 h in these 4 patients with presumably "mixed" GH/PRL secreting pituitary adenomas, compared with the response in 9 untreated acromegalic patients with normal basal PRL levels. In the 3 acromegalic patients with slightly elevated PRL levels, no or a normal increase of PRL levels in response to TRH was observed, while the suppressive effect of bromocriptine on plasma GH concentrations was not different from that seen in the acromegalic patients with normal PRL levels. However, as a group the 7 patients with hyperprolactinaemia showed a significantly higher GH-lowering effect to 2.5 mg bromocriptine than the 9 normoprolactinaemic acromegalic patients. A close relationship between the magnitude of the increment of GH in response to TRH and the decrease of plasma GH after 2.5 mg bromocriptine was present in the whole group of 16 acromegalics (P < 0.01). No such correlation was shown in the type of response of plasma GH to an oral glucose load or the coefficient of variation of basal plasma GH levels on 5 different days. It is concluded that in the population of acromegalic patients with elevated plasma PRL levels a sub-population of patients is present with "mixed" pituitary adenomas which secrete GH and PRL in a parallel manner. The characteristics of the secretion of both hormones, in these patients can be recognized as a parallel, delayed response of both hormones to TRH and an increased sensitivity to the suppressive effect of bromocriptine.

scholarly journals SAT-276 Co-Secreting TSH and Growth Hormone Pituitary Adenoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hatem Eid
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Case Reports ◽  
Somatostatin Analogs ◽  
Signs And Symptoms ◽  
Pituitary Hormones ◽  
Oral Glucose ◽  
Pituitary Macroadenoma ◽  
Α Subunit

Abstract Introduction: Secreting pituitary adenoma is exceedingly rare. Less than 15 cases having been reported. Its clinical presentation and diagnosis is challenging. We report a case of pituitary macroadenoma, with features of acromegaly and hyperthyroidism. Case report: A 75 years’ old man presented with new onset atrial fibrillation. He had high FT4 with normal TSH. His ultrasound scan of the neck showed a solitary nodule. He had ablation twice and was started on bisoprolol and anticoagulant. He had MRI scan for headaches and this showed a pituitary macroadenoma. He had high IGF-1. His oral glucose tolerance showed failure of GH suppression. His FT4 was persistently high with normal TSH and he had high a subunits. This suggested the diagnosis of TSH and GH secreting pituitary adenoma. Discussion: TSH-secreting pituitary adenomas are rare and not uncommonly, they co-secrete other pituitary hormones including growth hormones. Somatotrophs and lactotrops share common transcription factors with thyrotrophs. TSH-secreting adenomas are benign but 60% of them are locally invasive. TSH-secreting pituitary adenomas typically present with either symptoms of tumor growth like headache or visual field disturbance or symptoms of hyperthyroidism. Thyroid nodules are common in patients with TSHomas. In patients with TSH-secreting pituitary adenomas, majority will need only surgery and radiation. The medical treatment used to normalize TSH and FT4 levels is somatostatin analogs. This is effective in about 90% of patients with TSH secreting pituitary adenomas TSHoma should be differentiated from resistance to thyroid (RTH). The main difference between TSHoma and RTH is the presence of signs and symptoms of hyperthyroidism in patients with TSHoma, absence of a family history, normal thyroid hormone levels in family members, and the presence of an elevated glycoprotein α-subunit in patients with pituitary tumor. Reference: H Adams and D Adams. A case of a co-secreting TSH and growth hormone pituitary adenoma presenting with a thyroid nodule. EDM case reports 2018 [email protected]

scholarly journals Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

2021 ◽  
Vol 12 ◽  
Author(s):  
Tyler Cardinal ◽  
Casey Collet ◽  
Michelle Wedemeyer ◽  
Peter A. Singer ◽  
Martin Weiss ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Roc Curves ◽  
Subtotal Resection ◽  
Excessive Sweating ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
Postoperative Mri ◽  
Transsphenoidal Resection

PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.

Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion

2018 ◽  
Vol 117 ◽  
pp. e280-e289 ◽  
Author(s):  
Hun Ho Park ◽  
Eui Hyun Kim ◽  
Cheol Ryong Ku ◽  
Eun Jig Lee ◽  
Sun Ho Kim
Keyword(s):  
Growth Hormone ◽  
Surgical Resection ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Cavernous Sinus Invasion
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