Manouchehr Shirvani1, Rouzbeh Motiei-Langroudi2. 1. Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: dmshirvani@gmail.com. 2. Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract
OBJECTIVE: Transsphenoid surgery is the treatment of choice for growth hormone (GH)-producing pituitary adenomas. The measures that may predict postoperative remission need to be elucidated. METHODS: Transsphenoid surgery was performed in 163 patients by a single neurosurgeon from 1992 until 2010. Thirty-three patients were lost to follow-up, and the results of the remaining 130 are presented here. RESULTS: A total of 81.5% of patients obtained a first postoperative day GH level less than 5 μg/L, whereas 60.5% achieved a value less than 2.5 μg/L. A total of 56.9% had achieved both a GH less than 2.5 μg/L and normal insulin-like growth factor I (IGF-I) on delayed follow-up and could be regarded as in remission. Duration of symptoms before surgery, age, preoperative GH, and IGF-I levels did not significantly influence a patient's remission. Analysis showed that cavernous sinus extension and larger tumor size were associated with decreased remission rate, whereas sellar floor invasion or suprasellar extension did not significantly influence remission. CONCLUSION: The results of our study show that transsphenoid surgery is an optimal treatment modality for GH-secreting pituitary adenoma. Suprasellar or sellar floor invasion, and preoperative GH or IGF-I do not necessarily predict poor outcomes. Large tumor size and cavernous sinus extension contribute to greater recurrence rates.
OBJECTIVE: Transsphenoid surgery is the treatment of choice for growth hormone (GH)-producing pituitary adenomas. The measures that may predict postoperative remission need to be elucidated. METHODS: Transsphenoid surgery was performed in 163 patients by a single neurosurgeon from 1992 until 2010. Thirty-three patients were lost to follow-up, and the results of the remaining 130 are presented here. RESULTS: A total of 81.5% of patients obtained a first postoperative day GH level less than 5 μg/L, whereas 60.5% achieved a value less than 2.5 μg/L. A total of 56.9% had achieved both a GH less than 2.5 μg/L and normal insulin-like growth factor I (IGF-I) on delayed follow-up and could be regarded as in remission. Duration of symptoms before surgery, age, preoperative GH, and IGF-I levels did not significantly influence a patient's remission. Analysis showed that cavernous sinus extension and larger tumor size were associated with decreased remission rate, whereas sellar floor invasion or suprasellar extension did not significantly influence remission. CONCLUSION: The results of our study show that transsphenoid surgery is an optimal treatment modality for GH-secreting pituitary adenoma. Suprasellar or sellar floor invasion, and preoperative GH or IGF-I do not necessarily predict poor outcomes. Large tumor size and cavernous sinus extension contribute to greater recurrence rates.
Authors: Amy A Swanson; Dana Erickson; Diane Mary Donegan; Sarah M Jenkins; Jamie J Van Gompel; John L D Atkinson; Bradley J Erickson; Caterina Giannini Journal: Pituitary Date: 2020-10-19 Impact factor: 4.107
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