The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’
TLDR
It is suggested that surgery remains with very few exceptions the primary treatment of acromegaly for a high cure rate, low morbidity, low recurrence rate and immediate decline of GH.Abstract:
Background and aim The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure. Method We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used. Results The rate of biochemical 'cure' correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively). Conclusions These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.read more
Citations
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Acromegaly: An Endocrine Society Clinical Practice Guideline
Laurence Katznelson,Edward R. Laws,Shlomo Melmed,Mark E. Molitch,Mohammad Hassan Murad,Andrea L. Utz,John A.H. Wass +6 more
TL;DR: This evidence-based guideline addresses important clinical issues regarding the evaluation and management of acromegaly, including the appropriate biochemical assessment, a therapeutic algorithm, including use of medical monotherapy or combination therapy, and management during pregnancy.
Journal ArticleDOI
A Consensus on Criteria for Cure of Acromegaly
Andrea Giustina,Philippe Chanson,Marcello D. Bronstein,Anne Klibanski,Steven W. J. Lamberts,Felipe F. Casanueva,Peter J Trainer,Ezio Ghigo,Ken K. Y. Ho,Shlomo Melmed +9 more
TL;DR: Criteria to define active acromegaly and disease control were agreed, and several significant changes were made to the 2000 guidelines.
Journal ArticleDOI
Guidelines for Acromegaly Management: An Update
Shlomo Melmed,Annamaria Colao,Ariel L. Barkan,Mark E. Molitch,Ashley B. Grossman,David L. Kleinberg,David R. Clemmons,Philippe Chanson,Edward R. Laws,Janet A. Schlechte,Mary Lee Vance,Ken K. Y. Ho,Andrea Giustina +12 more
TL;DR: The group developed a consensus on the approach to managing acromegaly including appropriate roles for neurosurgery, medical therapy, and radiation therapy in the management of these patients.
Journal ArticleDOI
Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry
Wolfgang Saeger,Dieter K. Lüdecke,Michael Buchfelder,Rudolf Fahlbusch,Hans-Jürgen Quabbe,Stephan Petersenn +5 more
TL;DR: The German Registry of Pituitary Tumors was founded by thepituitary Section of the German Society of Endocrinology as a reference center for collection and consultant pathohistological studies of pituitary tumors and the new entity 'atypical adenoma' was found in 12 cases in 2005.
Journal ArticleDOI
Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series.
TL;DR: Although the results reveal excellent tumor-removal rates, comparable remission rates in functioning tumors, and a very low rate of complications, additional studies with longer follow-up periods are required to confirm whether this approach should be considered the preferred procedure for pituitary surgery.
References
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Criteria for cure of acromegaly: a consensus statement.
Andrea Giustina,Ariel L. Barkan,Felipe F. Casanueva,F. Cavagnini,Lawrence A. Frohman,Ken K. Y. Ho,Johannes D. Veldhuis,John A.H. Wass,Klaus von Werder,Shlomo Melmed,Shlomo Melmed +10 more
TL;DR: This statement summarizes the consensus achieved in discussions to develop a consensus defining the criteria for cure of acromegaly.
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Mortality and Cancer Incidence in Acromegaly: A Retrospective Cohort Study
TL;DR: Mortality rates due to colon cancer, all malignant disease, cardiovascular disease and overall mortality were increased with higher posttreatment GH leve...
Journal ArticleDOI
Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant.
Peter J Trainer,W. M. Drake,Laurence Katznelson,Pamela U. Freda,Herman-Bonert,van der Lely Aj,Eleni V. Dimaraki,Paul M. Stewart,K. E. Friend,Mary Lee Vance,G. M. Besser,John A. Scarlett,Michael O. Thorner,Craig Parkinson,Anne Klibanski,Powell Js,Ariel L. Barkan,Michael C. Sheppard,Malsonado M,Rose Dr,David R. Clemmons,Gudmundur Johannsson,B.-Å. Bengtsson,Stavros Stavrou,David L. Kleinberg,David M. Cook,Lawrence S. Phillips,Martin Bidlingmaier,Christian J. Strasburger,Hackett S,Kenneth A. Zib,Bennett Wf,Robert J. Davis +32 more
TL;DR: Treatment of patients who have acromegaly with pegvisomant with a growth hormone–receptor antagonist results in a reduction in serum IGF-I concentrations and in clinical improvement.
Journal ArticleDOI
Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly
Brooke Swearingen,Fred G. Barker,Laurence Katznelson,Beverly M. K. Biller,Steven K. Grinspoon,Anne Klibanski,N. Nicole Moayeri,Peter McL. Black,Nicholas T. Zervas +8 more
TL;DR: A retrospective review of patients who underwent transsphenoidal surgery at Massachusetts General Hospital between 1978 and 1996 suggests that the decreased survival previously reported to be associated with acromegaly can be normalized by successful surgical and adjunctive therapy.
Journal ArticleDOI
Determinants of clinical outcome and survival in acromegaly.
TL;DR: A retrospective analysis of patients treated at the Departments of Endocrinology and Neurosurgery, Auckland Hospital, New Zealand finds the determinants of final outcome following therapy for acromegaly remain uncertain.