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. 2023 Jan 1;24(1):74-79.
doi: 10.1227/ons.0000000000000421. Epub 2022 Nov 1.

Intraoperative Prediction of Long-Term Remission in Acromegaly

Marcus A Zachariah  1 , Jordan J Bozer  2 , Santino Cua  2 , Luciano M Prevedello  3 , Luma M Ghalib  4 , Douglas A Hardesty  5 , Ricardo L Carrau  6 , Lawrence S Kirschner  4 , Daniel M Prevedello  5
Affiliations

Intraoperative Prediction of Long-Term Remission in Acromegaly

Marcus A Zachariah et al. Oper Neurosurg. .

Abstract

Background: The features of long-term remission in acromegaly adenomectomy are incompletely understood. An intraoperative predictor for long-term outcome would be valuable for assessing resection of growth hormone (GH)-secreting tumors in real-time.

Objective: To evaluate whether intraoperative GH measurement could predict long-term outcomes for acromegaly.

Methods: In 47 patients, peripheral blood GH levels were measured thrice intraoperatively: once before tumor dissection, once during tumor dissection, and once after tumor dissection. Long-term remission was defined by age-appropriate, normalized insulin-like growth factor-1 at most recent follow-up and a random GH less than 1.0 ng/mL. Patients were only considered to be in long-term remission without the use of postoperative medical therapy for acromegaly or radiation therapy.

Results: The median length of follow-up was 4.51 (range: 0.78-9.80) years. Long-term remission was achieved in 61.7% (29/47) of operations. Like previous studies, cavernous sinus invasion (odds ratio [OR]: 0.060; 95% CI: 0.014-0.260; P value < .01), suprasellar extension (OR: 0.191; 95% CI: 0.053-0.681; P value<.01), and tumor size greater than 1 cm (OR: 0.177; 95% CI: 0.003-0.917; P value = .03) were associated with not being in long-term remission. The minimum GH measured intraoperatively predicted long-term outcome (area under the curve: 0.7107; 95% CI: 0.537-0.884; P value < .01). The odds ratio of remission in patients with the lowest quartile minimum intraoperative GH compared with patients with the highest quartile minimum intraoperative GH was 27.0 (95% CI: 2.343-311.171; P value < .01).

Conclusion: Minimum intraoperative GH may predict long-term outcome for acromegaly, which in principle could provide the pituitary neurosurgeon with real-time feedback and inform intraoperative decision making.

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References

    1. Melmed S. Medical progress: acromegaly. N Engl J Med. 2006;355(24):2558-2573.
    1. Dal J, Feldt-Rasmussen U, Andersen M, et al. Acromegaly incidence, prevalence, complications and long-term prognosis: a nationwide cohort study. Eur J Endocrinol. 2016;175(3):181-190.
    1. Lavrentaki A, Paluzzi A, Wass JA, Karavitaki N. Epidemiology of acromegaly: review of population studies. Pituitary. 2017;20(1):4-9.
    1. Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly. J Clin Endocrinol Metab. 2014;99(11):3933-3951.
    1. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly. Endocr Rev. 2004;25(1):102-152.