Endocrine Abstracts

Introduction: Excessive production of growth hormone (GH) in acromegaly is most commonly caused by a somatotroph pituitary adenoma. The therapeutic arsenal is based on selective transsphenoidal adenomectomy (STA) as a first-line treatment. The aim of our study was to determine predictive factors of postoperative biochemical remission in acromegalic patients.

Methods: We conducted a retrospective study including 18 acromegalic patients followed-up in the endocrinology department of Charles Nicolle hospital, who underwent STA. Clinical, biochemical, and tumor imaging data were extracted from medical records. According to postoperative biochemical investigation patients were subdivided into two groups: remission (normal IGF-1 and GH level < 1 ng/ml, 3 months postoperatively) versus persistence.

Results: There were 10 women and 8 men with a mean age of 42.9±12.9 years. Pituitary imaging showed a macroadenoma in 94% of cases with extrasellar extension in 61% of cases. Postoperative biochemical remission was seen in six patients (33%). Patients who achieved biochemical remission had significantly smaller tumors compared with those who did not attain remission (mean diameter 15.2 versus 25.6 mm; P=0.018). Moreover, locoregional invasion (P=0.043) and the persistence of a tumor remnant (P<10-3) were significantly associated with a decreased rate of biochemical remission. However, we did not find significant associations between postoperative biochemical remission and these parameters: age, sex, preoperative GH and IGF-1 levels, pituitary hormone deficiencies, visual impairment and the delay between the diagnosis of acromegaly and STA.

Conclusion: STA of somatotroph adenomas remains the only curative treatment in acromegaly. The biochemical remission rate obtained after STA ranges from 32 to 85% of cases. Consistent with literature, our study showed that postoperative biochemical remission rate is lower in case of voluminous adenomas, locoregional invasion and persistence of residual tumor.