Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022;112(4):345-357.
doi: 10.1159/000517476. Epub 2021 May 28.

Value of Early Post-Operative Growth Hormone Testing in Predicting Long-Term Remission and Residual Disease after Transsphenoidal Surgery for Acromegaly

Yi Yuen Wang  1   2 , Mueez Waqar  3   4 , Ahmed Abou-Zeid  1   5 , Tara Kearney  6 , Carmela Caputo  7 , Julian Davis  8 , Peter Trainer  9 , Claire Higham  9 , Federico Roncaroli  10 , Kanna K Gnanalingham  1
Affiliations
Free article

Value of Early Post-Operative Growth Hormone Testing in Predicting Long-Term Remission and Residual Disease after Transsphenoidal Surgery for Acromegaly

Yi Yuen Wang et al. Neuroendocrinology. 2022.
Free article

Abstract

Introduction: Surgical remission for acromegaly is dependent on a number of factors including tumour size, invasiveness, and surgical expertise. We studied the value of early post-operative growth hormone (GH) level as a predictor of outcome and to guide early surgical re-exploration for residual disease in patients with acromegaly.

Methods: Patients with acromegaly undergoing first-time endoscopic transsphenoidal surgery between 2005 and 2015, in 2 regional neurosurgical centres, were studied. Insulin-like growth factor-1 (IGF-1), basal GH (i.e., sample before oral glucose), and GH nadir on oral glucose tolerance test (OGTT) were tested at various time points, including 2-5 days post-operatively. Definition of disease remission was according to the 2010 consensus statement (i.e., GH nadir <0.4 μg/L during an OGTT and normalized population-matched IGF-1). Forward stepwise logistic regression was used to determine factors associated with remission.

Results: We investigated 81 consecutive patients with acromegaly, 67 (83%) of which had macroadenomas and 22 (27%) were noted to be invasive at surgery. Mean follow-up was 44 ± 25 months. Overall, surgical remission was achieved in 55 (68%) patients at final follow-up. On univariate analysis, the remission rates at the end of the study period for patients with early post-operative GH nadir on OGTT of <0.4 (N = 43), between 0.4 and 1 (N = 28), and >1 μg/L (N = 8) were 88, 54, and 20%, respectively. Similar results were seen with basal GH on early post-operative OGTT. On multivariate regression analysis, pre-operative IGF-1 (odds ratio of 13.1) and early post-operative basal GH (odds ratio of 5.0) and GH nadir on OGTT (odds ratio of 6.8) were significant predictors of residual disease. Based on a raised early GH nadir and post-operative MR findings, 10 patients underwent early surgical re-exploration. There was reduction in post-operative GH levels in 9 cases, of which 5 (50%) achieved long-term remission. There was an increased risk of new pituitary hormone deficiencies in patients having surgical re-exploration compared to those having a single operation (60 vs. 14%).

Conclusions: An early post-operative basal GH and GH nadir on OGTT are reliable predictors of long-term disease remission. It can be used to guide patients for early surgical re-exploration for residual disease, although there is increased risk of hypopituitarism.

Keywords: Acromegaly; Early tests; Growth hormone; Insulin-like growth factor-1; Oral glucose tolerance test; Remission.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

  • Prognostic Models in Growth-Hormone- and Prolactin-Secreting Pituitary Neuroendocrine Tumors: A Systematic Review.
    Dumitriu-Stan RI, Burcea IF, Salmen T, Poiana C. Dumitriu-Stan RI, et al. Diagnostics (Basel). 2023 Jun 19;13(12):2118. doi: 10.3390/diagnostics13122118. Diagnostics (Basel). 2023. PMID: 37371013 Free PMC article. Review.
  • Consensus on acromegaly therapeutic outcomes: an update.
    Melmed S, di Filippo L, Fleseriu M, Mercado M, Karavitaki N, Gurnell M, Salvatori R, Tsagarakis S, Losa M, Maffei P, Pereira AM, Geer EB, Katznelson L, van der Lely AJ, Bollerslev J, Esposito D, Webb SM, Zatelli MC, Valassi E, Neggers S, Chanson P, Ho KKY, Ioachimescu AG, Biller BMK, Samson SL, Kaiser UB, Schilbach K, Luque RM, Casanueva FF, Shimon I, Boguszewski CL, Biermasz N, Colao A, Pirchio R, Lamberts SWJ, Kadioglu P, Buchfelder M, Frara S, Chiloiro S, Petersenn S, Gadelha MR, Puig-Domingo M, Luger A, Brue T, Beckers A, Ferone D, Clemmons DR, Greenman Y, Marazuela M, Mortini P, Strasburger CJ, Giustina A. Melmed S, et al. Nat Rev Endocrinol. 2025 Aug 13. doi: 10.1038/s41574-025-01148-2. Online ahead of print. Nat Rev Endocrinol. 2025. PMID: 40804505 Review.
  • Consensus on criteria for acromegaly diagnosis and remission.
    Giustina A, Biermasz N, Casanueva FF, Fleseriu M, Mortini P, Strasburger C, van der Lely AJ, Wass J, Melmed S; Acromegaly Consensus Group. Giustina A, et al. Pituitary. 2024 Feb;27(1):7-22. doi: 10.1007/s11102-023-01360-1. Epub 2023 Nov 3. Pituitary. 2024. PMID: 37923946 Free PMC article.
  • The State of Machine Learning in Outcomes Prediction of Transsphenoidal Surgery: A Systematic Review.
    Yang DB, Smith AD, Smith EJ, Naik A, Janbahan M, Thompson CM, Varshney LR, Hassaneen W. Yang DB, et al. J Neurol Surg B Skull Base. 2022 Nov 23;84(6):548-559. doi: 10.1055/a-1941-3618. eCollection 2023 Dec. J Neurol Surg B Skull Base. 2022. PMID: 37854535 Free PMC article.

LinkOut - more resources