Endocrine Abstracts

Introduction: To assess outcome for patients with acromegaly treated at Royal Preston Hospital since 1st of January 2000.

Results: Out of 22 patients (12 presenting in the last 2 years) 20 had endoscopic transsphenoidal hypophysectomy and two were managed medically. Headaches, visual disturbance and characteristic morphological features were the main presenting problems. 4 were microadenomas and 18 macroadenomas\. Exact dimensions were only available in 15 of 18 macroadenomas of whom 10 had tumours >2 cm in size. In 50% (9/18) of these macroadenomas, chiasmal compression was demonstrated on MRI scan, although visual field defects were present in only 33% (6/18) and visual symptoms in only 22% (4/18). Pre op hormone deficiencies were present in 7/21 (33%); TSH deficiency in 9.5% (2/21), ACTH deficiency in 14% (3/21) and Gonadotrophin deficiency in 24% (5/21).

Visual fields improved in all six patients who had pre-operative defects. Second surgery was undertaken in eight patients (only 2 with tumour <2 cm) due to inadequate biochemical control of acromegaly. Twelve patients were treated with somatostatin analogues, five patients with cabergoline and three patients with pegvisomont. Attainment of ‘safe’ GH levels (mean GH <2 ng/ml during GH day curve) after surgery was achieved in 10/20 patients (3 of 3 microadenomas and 7 of 17 macroadenomas) and normalisation of IGF1 in 5/20. Following treatment with addition medical therapy normalisation of IGF1 has been achieved in 64% (14/22). Of the remaining 8 patients treatment has reduced IGF1 to less that 1.5×upper limit of normal in 6 patients (75%) and all of these patients are still undergoing titration of medical therapy.

Conclusion: Transsphenoidal pituitary surgery has been effective in correcting visual field defects. After adjustment for the relatively high number of patients with large tumours, achievement of biochemical control of acromegaly following surgery is similar to other published series.