Ximene Antunes1, Nina Ventura2, Gustavo Bittencourt Camilo3, Luiz Eduardo Wildemberg1,4, Andre Guasti5, Paulo José M Pereira5, Aline Helen Silva Camacho6,7, Leila Chimelli6, Paulo Niemeyer5, Mônica R Gadelha1,4, Leandro Kasuki8,9,10. 1. Neuroendocrinology Research Center / Endocrinology Division - Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 2. Radiology Division - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil. 3. Radiology Division - Instituição Hospital e Maternidade Terezinha de Jesus -Juiz de Fora, Minas Gerais, Brazil. 4. Neuroendocrinology Division - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil. 5. Neurosurgery Division - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil. 6. Neuropathology and Molecular Genetics Laboratory - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil. 7. Pathology Division - Instituto Nacional do Câncer, Rio de Janeiro, Brazil. 8. Neuroendocrinology Research Center / Endocrinology Division - Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. lkasuki@yahoo.com. 9. Neuroendocrinology Division - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil. lkasuki@yahoo.com. 10. Endocrinology Division - Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil. lkasuki@yahoo.com.
Abstract
BACKGROUND: Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery. PURPOSE: To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier. METHODS: Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH <1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission. RESULTS: Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (p = 0.017). A GH <1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity. CONCLUSION: Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.
BACKGROUND: Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery. PURPOSE: To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier. METHODS: Consecutive acromegalypatients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH <1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission. RESULTS: Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (p = 0.017). A GH <1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity. CONCLUSION: Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.
Entities:
Keywords:
Acromegaly; Early criteria of remission; Predictors of surgical outcome; Surgery
Authors: John A Jane; Robert M Starke; Mohamed A Elzoghby; Davis L Reames; Spencer C Payne; Michael O Thorner; John C Marshall; Edward R Laws; Mary Lee Vance Journal: J Clin Endocrinol Metab Date: 2011-06-29 Impact factor: 5.958
Authors: Iulia Potorac; Patrick Petrossians; Adrian F Daly; Franck Schillo; Claude Ben Slama; Sonia Nagi; Mouna Sahnoun; Thierry Brue; Nadine Girard; Philippe Chanson; Ghaidaa Nasser; Philippe Caron; Fabrice Bonneville; Gérald Raverot; Véronique Lapras; François Cotton; Brigitte Delemer; Brigitte Higel; Anne Boulin; Stéphan Gaillard; Florina Luca; Bernard Goichot; Jean-Louis Dietemann; Albert Beckers; Jean-François Bonneville Journal: Endocr Relat Cancer Date: 2015-01-02 Impact factor: 5.678
Authors: Hai Sun; Jessica Brzana; Chris G Yedinak; Sakir H Gultekin; Johnny B Delashaw; Maria Fleseriu Journal: J Neurol Surg B Skull Base Date: 2013-09-09
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
Authors: Andrea Giustina; Garni Barkhoudarian; Albert Beckers; Anat Ben-Shlomo; Nienke Biermasz; Beverly Biller; Cesar Boguszewski; Marek Bolanowski; Jens Bollerslev; Vivien Bonert; Marcello D Bronstein; Michael Buchfelder; Felipe Casanueva; Philippe Chanson; David Clemmons; Maria Fleseriu; Anna Maria Formenti; Pamela Freda; Monica Gadelha; Eliza Geer; Mark Gurnell; Anthony P Heaney; Ken K Y Ho; Adriana G Ioachimescu; Steven Lamberts; Edward Laws; Marco Losa; Pietro Maffei; Adam Mamelak; Moises Mercado; Mark Molitch; Pietro Mortini; Alberto M Pereira; Stephan Petersenn; Kalmon Post; Manuel Puig-Domingo; Roberto Salvatori; Susan L Samson; Ilan Shimon; Christian Strasburger; Brooke Swearingen; Peter Trainer; Mary L Vance; John Wass; Margaret E Wierman; Kevin C J Yuen; Maria Chiara Zatelli; Shlomo Melmed Journal: Rev Endocr Metab Disord Date: 2020-09-10 Impact factor: 6.514
Authors: Adriana G Ioachimescu; Talin Handa; Neevi Goswami; Adlai L Pappy; Emir Veledar; Nelson M Oyesiku Journal: Endocrine Date: 2019-11-01 Impact factor: 3.633
Authors: Ashley B Grossman; Shereen Ezzat; Sylvia L Asa; Ozgur Mete; Michael D Cusimano; Ian E McCutcheon; Arie Perry; Shozo Yamada; Hiroshi Nishioka; Olivera Casar-Borota; Silvia Uccella; Stefano La Rosa Journal: Mod Pathol Date: 2021-05-21 Impact factor: 7.842