The Outcome of Surgery in Patients with Growth Hormone Secreting Adenomas: Early Surgical Sntervention is Essential for improving the Surgical Cure Rate

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.

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Chapter-145 Growth Hormone Secreting Adenomas

Ramamurthi and Tandon�s Manual of Neurosurgery ◽

10.5005/jp/books/12212_60 ◽

2014 ◽

pp. 1098-1101

Author(s):

Ravi Ramamurthi

Keyword(s):

Growth Hormone ◽

Growth Hormone Secreting Adenomas

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Repeat Transsphenoidal Surgery for the Treatment of Remaining or Recurring Pituitary Tumors in Acromegaly

Neurosurgery ◽

10.1227/neu.0b013e3181ec4379 ◽

2010 ◽

Vol 67 (4) ◽

pp. 949-956 ◽

Cited By ~ 36

Author(s):

Shozo Yamada ◽

Noriaki Fukuhara ◽

Kenichi Oyama ◽

Akira Takeshita ◽

Yasuharu Takeuchi

Keyword(s):

Growth Hormone ◽

Growth Factor ◽

Adjuvant Therapy ◽

Surgical Outcome ◽

Transsphenoidal Surgery ◽

Hazard Ratio ◽

Insulin Like Growth Factor ◽

Cure Rate ◽

Factor I

Abstract BACKGROUND: Acromegaly is a disorder characterized by hypersecretion of growth hormone caused by a growth hormone–secreting pituitary adenoma. OBJECTIVE: To evaluate the long-term efficacy and safety of repeat transsphenoidal surgery for persistent or recurrent acromegaly. METHODS: We retrospectively reviewed records for 53 acromegalic patients who underwent repeat transsphenoidal surgery for persistent or progressive acromegaly at Toranomon Hospital between 1987 and 2006. Multivariate logistic regression was performed to evaluate preoperative factors influencing the surgical outcome. RESULTS: Thirty-one patients (58.5%) met the criteria for cure on long-term follow-up endocrine findings. Furthermore, 17 patients were well controlled with normal insulin-like growth factor I levels without (2 patients) or with medication (15 patients), whereas insulin-like growth factor I levels were still above normal in 5 patients after postoperative adjuvant therapy. Only 1 patient was undergoing additional hormonal replacement after surgery, although transient cerebrospinal fluid leak, transient abducens nerve palsy, severe nasal bleeding, and pituitary abscess occurred in each patient, respectively. Multivariate analysis clarified that a favorable surgical outcome was achieved in patients without cavernous sinus invasion (hazard ratio 12.56), tumor segmentation (hazard ratio 5.82), or in those older than 40 years old (hazard ratio 3.21). CONCLUSION: Repeat surgery can be performed safely with an approximately 60% long-term cure rate in this series. Reoperation should therefore be considered for persistent or recurrent disease in acromegalic patients in whom adjuvant therapy is not effective enough or cannot be accepted. The careful study of initial or preoperative magnetic resonance imaging and the use of micro-Doppler, endoscope, and eye movement monitoring device during surgery can help increase cure rate with a lower complication rate.

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Differential transduction of dopamine signal in different subtypes of human growth hormone-secreting adenomas.

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.78.2.7906281 ◽

1994 ◽

Vol 78 (2) ◽

pp. 411-417

Author(s):

A Spada ◽

M Bassetti ◽

F Reza-Elahi ◽

M Arosio ◽

P Gil-Del-Alamo ◽

...

Keyword(s):

Growth Hormone ◽

Human Growth Hormone ◽

Human Growth ◽

Dopamine Signal ◽

Growth Hormone Secreting Adenomas

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PLASMA GROWTH HORMONE HALF-LIFE AFTER SELECTIVE REMOVAL OF ADENOMA IN ACROMEGALICS DETERMINES THE OUTCOME OF SURGERY

Clinical Endocrinology ◽

10.1111/j.1365-2265.1988.tb01203.x ◽

1988 ◽

Vol 28 (1) ◽

pp. 51-59 ◽

Cited By ~ 11

Author(s):

F. ROELFSEMA ◽

D. HEIDE ◽

P. J. LOWRY ◽

H. DULKEN ◽

J. SCHRÖDER-VAN DER ELST

Keyword(s):

Growth Hormone ◽

Half Life ◽

Selective Removal ◽

Plasma Growth Hormone ◽

Outcome Of Surgery

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Does Adenotonsillectomy Cure Pediatric Sleep Apnea?

Otolaryngology ◽

10.1016/j.otohns.2008.05.205 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P63-P64

Author(s):

Michael Friedman ◽

Rohit Soans ◽

Ziya Bozkurt ◽

Hsin-Ching Lin ◽

Ninos J Joseph

Keyword(s):

Sleep Apnea ◽

Meta Analysis ◽

Treatment Success ◽

Primary Treatment ◽

Inclusion Criteria ◽

Cure Rate ◽

Effect Measure ◽

Surgical Cure ◽

Pediatric Sleep

Objective 1) Perform an updated meta-analysis to determine the cure rate of adenotonsillectomy for pediatric sleep apnea. 2) Report the findings of 5 years of experience with standardized coblation intracapsular tonsillectomy for the treatment of pediatric sleep apnea. Methods A thorough literature search of multiple databases was performed. Inclusion criteria for studies were: 1) Adenotonsillectomy as the primary treatment of sleep apnea (age<18). 2) Pre-and postoperative polysomnography data was included. 20 studies fit the inclusion criteria and a metaanalysis was performed to determine the overall success. A 5–year retrospective analysis of coblation tonsillectomy performed by a single surgeon for sleep apnea was also performed. Results The meta-analysis included 904 subjects with average follow-up time of 21.6 weeks. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k= 20 studies) with T/A based on pre-and postoperative PSG data. Random-effects model estimated the treatment success of adenotonsillectomy was 61.1%. When “cure” was defined as an AHI of <1, the cure rate was 53.8%. 200 adenotonsillectomy cases performed with coblation technique were reviewed. The mean preoperative was AHI 28.3 and mean postoperative AHI was 3.8. Surgical cure, as defined as a postoperative AHI <1, was achieved in 51.7% of patients. Conclusions 1) Contrary to popular belief, meta-analysis of current literature and a review of 200 cases demonstrates that pediatric sleep apnea is often not cured by adenotonsillectomy. 2) Although complete resolution is not achieved in most cases, adenotonsillectomy still offers significant improvements in AHI.

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Selective Loss of Somatostatin Receptor 2 in Octreotide-Resistant Growth Hormone-Secreting Adenomas

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-1986 ◽

2008 ◽

Vol 93 (4) ◽

pp. 1203-1210 ◽

Cited By ~ 66

Author(s):

Ursula Plöckinger ◽

Susann Albrecht ◽

Christian Mawrin ◽

Wolfgang Saeger ◽

Michael Buchfelder ◽

...

Keyword(s):

Growth Hormone ◽

Maximum Dose ◽

Somatostatin Receptor ◽

Somatostatin Analogs ◽

Gh Secretion ◽

Selective Loss ◽

Octreotide Treatment ◽

Group A ◽

Group B ◽

Growth Hormone Secreting Adenomas

Abstract Objective: The somatostatin analog octreotide preferentially binds to somatostatin receptor (sst) 2A and to a lesser extent to sst5. Although sst2A and sst5 mRNAs are consistently expressed in GH-secreting adenomas, octreotide controls GH secretion only in 65% of acromegalic patients. Hence, we investigated the immunocytochemical expression of sst in a large group of somatotroph tumors. Methods: Acromegalic patients, cared for in a university referral center, were either operated on without pretreatment (group A, n = 14) or pretreated with octreotide [median (minimum-maximum): dose 1250 (300–1500) μg/d for 5.6 (3–9) months] before surgery (group B, n = 20). In group B octreotide reduced GH secretion by more than 50% in 14 patients (70%) (GH responders). Six patients with less than 50% GH suppression were considered GH nonresponders. We used a panel of extensively characterized antibodies to determine the immunocytochemical sst status in somatotroph adenomas and compared their expression between the groups. Results: All group A tumors demonstrated immunoreactive sst2A, and all but one had sst5. A similar pattern was found in the GH responders of group B. In contrast, none of the GH nonresponders exhibited detectable sst2A (sst2A: GH responders vs. GH nonresponders, P < 0.0001), whereas sst5 was found in 70%. sst1 and sst3 were detected in 85 and 24% of all cases, independent of previous octreotide treatment. Conclusions: Our findings suggest that octreotide resistance in GH-secreting adenomas occurs due to a selective loss of sst2A. The persistent expression of sst1 and sst5 receptors suggests that these tumors are potential targets for pan-somatostatin analogs.

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