Endocrine Abstracts

Objective: To analyze characteristics of patients who had surgery for a GH-secreting adenoma in the past decade in our centre, to evaluate their initial outcome and long-term recurrence rate using stringent criteria and identify potential predictive factors of surgical remission.

Methods: This retrospective study included 115 consecutive patients with acromegaly operated at the neurosurgical department of the Timone Hospital Marseille between 1997 and 2007, with a mean follow-up of 3.8 years.

Results: Using stringent criteria (GH nadir at oral glucose tolerance test (OGTT) ≤0.4 μg/l and normalisation of IGF-1 level), remission rate at 3 month was 37.4% (65% for microadenomas and 31.6% for macroadenomas). A subset of patients (23.5%) had discordant values in terms of GH/OGTT or IGF-1 levels. Only 7.8% of patients had surgical complications and no mortality was observed. In multivariate analysis, preoperative mean GH level, tumour invasion and surgical observation of total resection were significant predictors of surgical outcome. Beneficial effect of preoperative medical treatment was significant in univariate analysis, independently of confounding factors. We observed only 2% of long-term recurrence. At the end of follow-up, acromegaly was controlled in 90.9% of patients with or without adjunctive treatment (including 49.5% after surgery only).

Conclusion: Using stringent criteria for remission, a very low recurrence rate was observed in this study. The best results of pituitary surgery were obtained in non invasive adenomas with low preoperative GH levels. Presurgical medical treatment was also a significant factor related to remission. Nevertheless improvement of long-term control of acromegaly in the context of newly available therapeutic options is likely to modify the management of such patients.