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. 2020 Apr;68(1):182-191.
doi: 10.1007/s12020-020-02227-2. Epub 2020 Feb 20.

Random Gh and Igf-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission

Marcelo Lemos Vieira da Cunha  1 , Luis Alencar Biurrum Borba  1 , Cesar Luiz Boguszewski  2
Affiliations

Random Gh and Igf-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission

Marcelo Lemos Vieira da Cunha et al. Endocrine. 2020 Apr.

Abstract

Purpose: To evaluate the role of IGF-I and random GH measurements 3 months after transsphenoidal surgery (TSS) in predicting long-term remission in acromegaly patients.

Methods: Retrospective analysis of 54 acromegaly patients who underwent TSS with the same neurosurgery team. Random GH and IGF-I values evaluated 3 months after TSS were related to long-term outcomes. The initiation of adjuvant therapy at any time defined surgical failure.

Results: At 3 months, 14 (25.9%) patients had controlled disease (CD; normal IGF-I and GH < 1.0 µg/L), 25 (46.3%) had uncontrolled disease (UD; high IGF-I and GH), and 15 (27.8%) had biochemical discrepancies (BD): 12 BDI (normal IGF-I + GH ≥ 1.0 μg/L) and 3 BDII (high IGF-I + GH < 1.0 μg/L). All patients of the CD group, 2 of the UD, 11 of the BDI, and 2 of the BDII, progressed with long-term remission and had IGF-I ≤ 1.25-fold the Upper Limit of Normal (ULN), in contrast with all cases of surgical failure where IGF-I was ≥1.3-fold ULN. Only one patient with normal IGF-I had recurrence, resulting in 100% sensitivity and 96% specificity of post-surgical IGF-I ≤ 1.25-fold ULN to predict long-term remission, observed in 54% of our cohort. Post-surgical random GH ≥ 1.7 µg/L was the best cutoff to identify surgical failure, but its accuracy to predict long-term outcomes was limited.

Conclusions: IGF-I levels ≤ 1.25-fold ULN 3 months after TSS was the best guide for long-term remission in acromegaly patients with both initial surgical failure and discrepant biochemical results.

Keywords: Acromegaly; GH-secreting; Neurosurgery; Neurosurgical; Pituitary adenoma; Procedure.

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References

    1. C. Beauregard, U. Truong, J. Hardy, O. Serri, Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin. Endocrinol. 58(1), 86–91 (2003) - DOI
    1. J.A. Gondim, J.P. Almeida, L.A. de Albuquerque, E. Gomes, M. Schops, T. Ferraz, Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurg. Focus 29(4), E7 (2010). https://doi.org/10.3171/2010.7.FOCUS10167 - DOI - PubMed
    1. C.P. Hofstetter, R.H. Mannaa, L. Mubita, V.K. Anand, J.W. Kennedy, A.R. Dehdashti, T.H. Schwartz, Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurg. Focus 29(4), E6 (2010). https://doi.org/10.3171/2010.7.FOCUS10173 - DOI - PubMed
    1. H. Nishioka, N. Fukuhara, K. Horiguchi, S. Yamada, Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes. J. Neurosurg. 121(3), 505–510 (2014). https://doi.org/10.3171/2014.3.JNS132214 - DOI - PubMed
    1. R.M. Starke, D.M. Raper, S.C. Payne, M.L. Vance, E.H. Oldfield, J.A. Jane Jr, Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J. Clin. Endocrinol. Metab. 98(8), 3190–3198 (2013). https://doi.org/10.1210/jc.2013-1036 - DOI - PubMed

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