Faculty Collaboration Database

SIGNIFICANT ELEVATION OF GROWTH HORMONE LEVEL IMPACTS SURGICAL OUTCOMES IN ACROMEGALY. Endocr Pract 2015 Sep;21(9):1001-9

Date

06/30/2015

Pubmed ID

26121434

DOI

10.4158/EP14587.OR

Scopus ID

2-s2.0-84982161837 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

OBJECTIVE: Transsphenoidal adenomectomy (TSA) is first-line treatment for acromegaly. Our aim was to determine the impact of pre-operative biochemical parameters on the outcomes of surgery.

METHODS: Retrospective case series of 79 consecutive acromegalics operated between 1994 and 2013. Inclusion criteria were: first TSA, pathology-confirmed growth hormone (GH) adenoma, and follow-up >3 months. Biochemical remission was defined as normal insulin-like growth factor 1 (IGF-1) without adjuvant therapy during follow-up.

RESULTS: Median follow-up was 35.4 months (range, 3 to 187 months). Logistic regression analysis showed that the best model to predict long-term remission included the following pre-operative markers: GH, tumor diameter, and cavernous sinus invasion (CSI) (area under the curve, 0.933). A threshold GH of 40 ng/mL was associated with long-term remission (sensitivity, 97%; specificity, 42%). Group A (GH >40 ng/mL) comprised 19 patients (9 men); age, 43 ± 13 years; tumor diameter, 2.7 ± 1.0 cm; 73.7% with CSI; and pre-operative median GH, 77.8 ng/mL (interquartile range [IQR], 66.7 to 107.0 ng/mL). Three patients (15%) in group A achieved remission at 3 months, but 2 patients recurred during follow-up. Group B (GH ≤40 ng/mL) comprised 60 patients (25 men); age, 47 ± 13 years; tumor diameter, 1.6 ± 1.0 cm; 35% with CSI, preoperative median GH, 6.9 ng/mL (IQR, 3.4 to 16.9 ng/mL). Thirty-five patients (58%) in group B achieved remission at 3 months without recurrence during follow-up. Group A had larger tumors and a higher proportion of tumors with CSI (P<.05).

CONCLUSION: Both GH and IGF-1 should be measured pre-operatively, as highly elevated GH levels negatively impact long-term surgical remission. This strategy allows early identification of patients who require adjuvant therapy and may decrease time to biochemical control.

Author List

Anthony JR, Alwahab UA, Kanakiya NK, Pontell DM, Veledar E, Oyesiku NM, Ioachimescu AG

Author

Adriana G. Ioachimescu MD, PhD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acromegaly
Adult
Chemotherapy, Adjuvant
Disease-Free Survival
Female
Growth Hormone-Secreting Pituitary Adenoma
Human Growth Hormone
Humans
Insulin-Like Growth Factor I
Male
Middle Aged
Neoplasm Recurrence, Local
Radiotherapy, Adjuvant
Remission Induction
Retrospective Studies
Treatment Outcome