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. 2014 Feb;75(1):47-52.
doi: 10.1055/s-0033-1354578. Epub 2013 Sep 9.

Factors associated with biochemical remission after microscopic transsphenoidal surgery for acromegaly

Hai Sun  1 , Jessica Brzana  2 , Chris G Yedinak  3 , Sakir H Gultekin  4 , Johnny B Delashaw  5 , Maria Fleseriu  6
Affiliations

Factors associated with biochemical remission after microscopic transsphenoidal surgery for acromegaly

Hai Sun et al. J Neurol Surg B Skull Base. 2014 Feb.

Abstract

Objectives To analyze surgical outcomes and predictive factors of disease remission in acromegaly patients who underwent microscopic transsphenoidal surgery (TSS) for a growth hormone (GH)-secreting adenoma. Design A 6-year retrospective review of 86 consecutive acromegaly surgeries. Setting Procedures performed at a single institution by a single surgeon. Participants Seventy acromegaly patients. Main Outcome Measures Demographic information, preoperative laboratory values, tumor imaging data, and morphological and immunohistochemical data were collected. Predictive values using the latest and most stringent biochemical remission criteria were determined using univariate and multivariate statistical analyses. Results Remission rate for 59 (18 males) acromegaly patients meeting the study inclusion criteria was 52.5%. Remission rates for micro- and macroadenomas were 81.8% and 45.8%, respectively. Patients of older age, with a smaller tumor, lower Knosp grade, lower preoperative GH, and insulinlike growth factor 1 levels were more likely to achieve remission. Remission rate decreased significantly with repeat surgeries. Those patients with adenomas that stained positive for somatostatin receptor subtype 2A were less likely to experience tumor recurrence and more likely to respond to medical treatment with persistent or elevated GH hypersecretion. Conclusions Microscopic TSS continues to be a viable means for treating acromegaly patients. Patients should be followed long term.

Keywords: acromegaly; remission; transsphenoidal surgery.

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Conflict of interest statement

Disclosures Dr. Fleseriu has received consultant fees from Novartis Pharmaceuticals and Ipsen and is a principal investigator in clinical trials sponsored by Novartis Pharmaceuticals and Ipsen with research support to Oregon Health & Science University. Dr. Sun is in receipt of funds from the Congress of Neurological Surgeons Christopher C. Getch Flagship Fellowship Award. The remaining authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Bar graph showing no histologic pattern, densely granulated, sparsely granulated, or mixed growth hormone/patchy prolactin (GH/PRL) was predictive of surgical remission (p = 0.78).
Fig. 2
Fig. 2
Bar graph showing surgical remission rates were similar between somatostatin receptor subtype 2A (SSTR2A)-positive and SSTR2A-negative tumors (55.6% and 57.1%, respectively; p = 0.933).
Fig. 3
Fig. 3
Bar graph showing recurrence rate was lower for somatostatin receptor subtype 2A (SSTR2A)-positive than SSTR2A-negative tumors: 11% and 57%, respectively (p = 0.003).
Fig. 4
Fig. 4
Bar graph showing surgical remission rate decreased significantly with number of transsphenoidal surgery (TSS) (p = 0.03). After a first TSS, ∼44% of patient went into remission; after a second TSS, only 25% reached remission.
See this image and copyright information in PMC

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