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Ten-Year Follow-Up Results of Transsphenoidal Microsurgery in Acromegaly

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J Clin Endocrinol Metab Biermasz et al. 85 (12): 4596. (178K

Abstract Fifty-nine acromegalic patients, transsphenoidally operatedby a single neurosurgeon (H.v.D.) were followed for at least10 yr to assess the late outcome of surgery. Mean follow-upwas 16 ± 0.4 yr (range, 10–22). Criteria for remissionwere a serum GH concentration below 2.5 µg/L, a normalglucose-suppressed GH (oral glucose tolerance test), and a normalserum insulin-like growth factor I (IGF-I) concentration. Meanserum GH concentration decreased from 59 ± 8.7 µg/Lto 5.6 ± 1.4 µg/L after surgery. Early postoperativeremission rates were 61% (GH, <2.5 µg/L), 67% (suppressedGH), and 60% (both GH <2.5 µg/L and suppressed GH). Earlypostoperative remission was significantly related to preoperative serumGH concentration (P = 0.023), but not to tumor size. Of 36 patientswith postoperative remission (GH, <2.5 µg/L), 9 patientsreceived (prophylactic) radiotherapy for persistent paradoxicalreaction to TRH or probable invasive tumor growth. All nine patientsare in remission at the end of follow-up. Of the other 27 patientswith postoperative remission, 5 (19%) developed recurrence, becomingevident within 5 yr in 4 patients and after 10 yr in 1 patient.Of these 27 patients, surgical remission rates at the end of follow-upare 78% (random GH, <2.5 µg/L), 73% (normal glucose-suppressedGH), 74% (normal IGF-I), and 65% (normal IGF-I and GH suppression).Of the patients with postoperative persistent disease, 18 patientswere irradiated and 5 patients were followed without furthertreatment. Two of five nontreated patients had spontaneous normalizationof GH concentration at the 6 months visit and remained in remissionby surgery only. The long-term efficacy of multimodality treatmentwas evaluated after exclusion of the prophylactically irradiatedpatients. At the end of follow-up, 48% of patients had not requiredadjuvant therapy and the rest received radiotherapy (34%), octreotide(10%), or both (8%). Remission rates of multimodality therapywere 96% (serum GH, <2.5 µg/L) and 94% (normal serumIGF-I concentration). Remission rates of transsphenoidal surgeryalone were 46% (serum GH, <2.5 µg/L), 44% (normal IGF-Iconcentration), 41% (suppressed serum GH), and 37% (normal serumIGF-I and suppressed GH). In this first report on separate 10or more years results of transsphenoidal surgery for acromegaly,using strict criteria for remission, 19% of patients with postoperativeremission developed recurrence. Nevertheless, about 40% of patientsremain in remission after only surgical intervention, even aftera mean follow-up of 16 yr.