BES2003 Poster Presentations Endocrine Tumours and Neoplasia (47 abstracts)
Transsphenoidal surgery for acromegaly in Wales: Results based on stringent criteria of remission
P De 1 , DA Rees 1 , N Davies 1 , R John 2 , J Neal 3 , RG Mills 4 , J Vafidis 5 , JS Davies 1 & MF Scanlon 1
1Department of Endocrinology, Metabolism, Diabetes; University Hospital Wales (UHW), Cardiff, UK; 2Department of Biochemistry, UHW, Cardiff, UK; 3Department of Histopathology, UHW, Cardiff, UK; 4Department of ENT Surgery, UHW, Cardiff, UK; 5Department of Neurosurgery, UHW, Cardiff, UK.
Aim: To analyse outcome of transsphenoidal surgery for acromegaly in Wales using stringent remission criteria.
Method: We retrospectively analysed 90 patients who underwent transsphenoidal surgery (performed by 3 surgeons) as initial therapy for acromegaly in our centre between January 1980 and December 2001. A combination of modern, evidence-based remission criteria including mean day curve GH < 5 mU/l and /or a nadir GH < 2 mU/l after an oral glucose tolerance test (OGTT) and /or normal age-related IGF-1 levels (where available) were used.
Results: 57 (63%) out of 90 patients remained in remission following surgery. 79% patients with microadenomas but only 56% patients with macroadenomas achieved remission (P< 0.001). 79% patients with microadenomas and 75% with intrasellar macroadenomas were in remission as compared to 28 % with extrasellar macroadenomas (P < 0.002). 86% patients with pre-operative GH levels < 20 mU/l(day profile or following OGTT) went into remission compared to 51% patients with GH levels > 50 mU/l at diagnosis (P < 0.002). Remission rate was also related to the period of surgery which was significantly higher in 1998-2001 (76%, P < 0.05) compared to 1990-1997 (54%) and 1980-1989 (63%).There were no recurrences or peri-operative deaths.Meningitis occurred in 3%, CSF rhinorrhoea in 7% and permanent DI in 15% patients. The proportion of patients who developed new anterior pituitary hormone deficiencies and pan-hypopituitarism was significantly less in the period 1998-2001 (P < 0.001) when compared to the period between 1990-1997 and between 1980-1989.
Conclusion: Our results compare favourably with all published series. Success was related to tumour size, intrasellar confinement, preoperative GH level and surgeon. The outcome of surgical treatment for acromegaly is best achieved with one surgeon specialising in pituitary surgery as borne out in our series with higher cure rates and less surgery-related complications since the advent of a specialist pituitary neurosurgeon in 1998.
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Endocrine Abstracts
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