Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors

Harish Babu, Alicia Ortega, Miriam A Nuno, Aaron Dehghan, Aaron Schweitzer, H. Vivien Bonert, John D. Carmichael, Odelia Cooper, Shlomo Melmed, Adam N. Mamelak

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

BACKGROUND: Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented. OBJECTIVE: To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness. METHODS: We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center. Hormonal remission was established by normal insulin-like growth factor (IGF)-1, basal serum growth hormone <2.5 ng/mL, and growth hormone suppression to <1 ng/mL following oral glucose tolerance test. Oral glucose tolerance test was performed at 3 months after surgery, and then as indicated. IGF-1 was measured at 3 months and then at least annually. We evaluated tumor granularity, nuclear expression of p21, Ki67 index, and extent of cavernous sinus invasion, and correlated these with remission status. RESULTS: Fifty-eight patients that underwent surgery had follow-up from 38 to 98 months (mean 64 ± 32.2 months). There were 21 microadenomas and 37 macroadenomas. Three months after surgery 40 of 58 patients (69%) were in biochemical remission. Four additional patients were in remission at 6 months after surgery, and 1 patient had recurrence within the first year after surgery. At last follow-up, 43 of 44 (74.1%) of patients remained in remission. Cavernous sinus invasion by tumor predicted failure to achieve remission. CONCLUSIONS: Prognostic markers of disease aggressiveness other than cavernous sinus invasion did not correlate with surgical outcome. Long-term remission after surgery alone was achieved in 74% of patients, indicating long-term efficacy of endoscopic surgery.

Original languageEnglish (US)
Pages (from-to)357-366
Number of pages10
JournalNeurosurgery
Volume81
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Keywords

  • Acromegaly
  • Endoscopy
  • Long-term
  • Outcomes
  • Transsphenoidal

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Babu, H., Ortega, A., Nuno, M. A., Dehghan, A., Schweitzer, A., Bonert, H. V., Carmichael, J. D., Cooper, O., Melmed, S., & Mamelak, A. N. (2017). Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors. Neurosurgery, 81(2), 357-366. https://doi.org/10.1093/neuros/nyx020