Endocrine Abstracts

Introduction: Persistence after transsphenoidal surgery remain a significant challenge in management of acromegaly. Value of basal growth hormone (GH) evaluation in early postoperative period as marker of acromegaly persistence has been proposed and discussed in the literature, but is not widely used in clinical practice.

Aim: The goal of our study is to specify the value of basal GH level measurement 24 hours later after transsphenoidal surgery as postoperative biomarker for surgical outcome in patients with acromegaly.

Materials and methods: A total of 18 patients (12 women and 6 men) with an average age of 48.9±13.5 years (range 27-66 years) were enrolled in our study. All patients underwent total transsphenoidal adenomectomy performed by one neurosurgeon. All patients harbored macroadenomas, with average size of 18.3±4.9 mm (range 11-29 mm). Measurement of a 24-hours postoperative GH level was performed in all patients. The outcome of surgery via OGTT and measurement of insulin-like growth factor 1 (IGF-1) was evaluated 6 months after surgery. The biochemical remission of acromegaly according to the 2010 remission criteria are defined as nadir GH level on an OGTT <0.4 μg/l along with age and gender normalized values of IGF-1.

Results: At baseline basal GH level was 36.4±23.5 μg/l, IGF-1 was 2.5±0.6 times the upper limit of normal. At 6 months after surgery, the remission of acromegaly was achieved in 8 patients (44%). A 24-hours postoperative GH level in patients with remission was 1.4±0.5 μg/l, whereas in group with acromegaly persistence –5.3±1.7 μg/l. All patients with persistence of the disease had a 24-hours postoperative GH level ≥ 2.0 μg/l.

Conclusion: Our study suggests that a 24-hours postoperative GH level above 2.0 μg/l associated with persistence of acromegaly 6 months after surgery.