Predictors of surgical outcome and early criteria of remission in acromegaly

Ludmila Astafyeva; Alexsey Shkarubo; R.A. Ibrahim Sameh; Inna Badmaeva; Yuliya Sidneva; Julia Strunina; Maxim Kutin; Dmitrii Fomicev; Oleg Sharipov; Dmitrii Andreev; Ilya Chernov; Pavel Kalinin

doi:10.1530/endoabs.81.EP669

Objective: To analyze the remission factors of surgical treatment of acromegaly

Methods: A retrospective study involving 227 patients with acromegaly: 143 (63%) women and 84 (37%) men were operated via trassphenoidal endoscopic approach for pituitary adenoma removal between the periods of 2018-2021. The average age was 45 years [36.00, 56.00]. 118 patients had 6 months follow-up period (3-40 months). The IGF-1 index used for the evaluation, which was calculated using the formula: IGF-1 index = IGF-1 patient (ng/ml) /upper reference interval IGF-1 for this age (ng/ml). The remission for acromegaly was considered as decrease of the IGF-1 index less than 1.0 not later than 3 months following surgery. Intrasellar adenomas were observed in 99 (44%) cases, 128 (56%) tumors had different directions of extrasellar growth (suprasellar in 81, infrasellar in 28 and laterosellar in 64 cases). The tumor size were classified into microadenomas – 20 (8,8%) (≤10 mm in diameter), small and medium (10-35 mm)-164(72,2%), large (36-59 mm)-38(16,7%), giant (≥60 mm)-5(2,0%).

Results: Remission after the surgical procedure was achieved in 65 (55%) of 118 cases with a long follow-up period. The average [IQR] age of patients in the group with remission - 46 years [37,56], and those without remission - 39.00 [31, 50] years (P=0.044). Median [IQR] GH before surgery in the group with remission was 10,77 ng/ml [5.84, 21.23], without remission – 28,00 [9.02, 65.75] (P=0.001). Following the removal of microadenomas or macroadenomas of smaller and medium sizes, remission was achieved in 8(88,9%) and 50(58,8%) cases respectively, during the removal of tumors of large and giant sizes remission was achieved only in 7(29,2%) cases (P=0,004). Considering the intrasellar localization of the tumor, remission was achieved at 36(75%) cases, whereas with adenoma with extrasellar growth in 29(41,4%) cases (P=0,001). The risk of surgical treatment of acromegaly was low: postoperative transient diabetes insipidus was noted in 16,7% of cases, hyponatremia - in 4,8%, rhinorrhea - in 1,3%, meningitis - in 0,88%, epistaxis in one (0,4%) and visual impairment in one (0,4%) case. There were no deaths.

Conclusion: Significantly predictors affecting the remission of acromegaly were recorded in average aged, the absence of visual disturbances, low GH level before surgery, the presence of microadenoma or small and medium-sized pituitary macroadenoma, the absence of extrasellar tumor growth, a decrease in GH <2,06 ng/ml and IGF-1 index<1,9 in the early postoperative period, the absence of residual tumor tissue after surgery.

Endocrine Abstracts

EP669