Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients.

Abstract

INTRODUCTION:

Given the new therapeutic options in acromegaly, it seemed important to evaluate the outcome of operated acromegalic patients today.

OBJECTIVE:

To analyse the characteristics and short- and long-term surgical outcome of patients who underwent transsphenoidal surgery for a growth hormone (GH)-secreting adenoma in our centre and to determine predictive factors of remission.

DESIGN AND PATIENTS:

This retrospective 10-year study included 115 newly diagnosed acromegalic patients operated on at Timone University Hospital, Marseille, France, between 1997 and 2007.

MEASUREMENTS:

Initial and long-term outcomes were evaluated using stringent and current remission criteria, associating GH nadir after oral glucose tolerance test <0·4 μg/l and normal insulin-like growth factor-1 (IGF-1) at 3 months, and a normal IGF-1 at the end of follow-up (52·4 ± 36·8 months, median 41 months, range 6·7-135·4 months, n = 99).

RESULTS:

At the end of follow-up, 90·9% of patients had controlled disease. Overall, 49·5% of patients were in long-term remission after surgery alone, and only 2·0% of patients experienced recurrent disease. Multivariate predictors of 3-month remission included mean GH at diagnosis (P = 0·033), tumour invasion (P = 0·013) and surgeon report of incomplete or uncertain macroscopic resection (P = 0·003 and P = 0·047, respectively). Multivariate predictors at diagnosis of long-term remission included mean GH level (P = 0·048), adenoma size (P = 0·007) and absence of pituitary deficit (P = 0·026).

CONCLUSIONS:

In long-term follow-up after surgery of acromegaly, half of the patients achieved remission after surgery alone and more than 90% had their disease controlled. With stringent 3-month remission criteria, recurrence was rare.

• Authors: Frédérique Albarel, Frédéric Castinetti, Isabelle Morange, Bernard Conte-Devolx, Jean Gaudart, Henry Dufour, Thierry Brue
• Journal: Clinical endocrinology (Clin Endocrinol (Oxf)) Vol. 78 Issue 2 Pg. 263-70 (Feb 2013) ISSN: 1365-2265 [Electronic] England
• PMID: 22783815 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 Blackwell Publishing Ltd.

Chemical References

• Dopamine Agonists
• Somatostatin

Topics

• Acromegaly (therapy)
• Adenoma (therapy)
• Adult
• Aged
• Aged, 80 and over
• Dopamine Agonists (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Somatostatin (analogs & derivatives, therapeutic use)
• Treatment Outcome
• Young Adult