Departments of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia 22908-0711, USA.
J Clin Endocrinol Metab. 2011 Sep;96(9):2732-40. doi: 10.1210/jc.2011-0554. Epub 2011 Jun 29.
Despite the growing application of endoscopic transsphenoidal surgery (ETSS), outcomes for GH adenomas are not clearly defined.
We reviewed our experience with ETSS with specific interest in remission rates using the 2010 consensus criteria, predictors of remission, and associated complications.
This was a retrospective single institution study. PATIENTS, INTERVENTIONS, AND OUTCOME MEASURES: Sixty acromegalic patients who underwent ETSS were identified. Remission was defined as a normal IGF-I and either a suppressed GH less than 0.4 ng/ml during an oral glucose tolerance test or a random GH less than 1.0 ng/ml.
Remission was achieved in all 14 microadenomas and 28 of 46 macroadenomas (61%). Tumor size, age, gender, and history of prior surgery were not predictive on multivariant analysis. In hospital postoperative morning GH levels less than 2.5 ng/ml provided the best prediction of remission (P < 0.001). Preoperative variables predictive of remission included Knosp score (P = 0.017), IGF-I (P = 0.030), and GH (P = 0.042) levels. New endocrinopathy consisted of diabetes insipidus in 5%, adrenal insufficiency in 5.4%, and new hypogonadism in 29% of men and 17% of women. However, 41% of hypogonadal men had normal postoperative testosterone levels and 83% of amenorrheic women regained menses. The most common complaints after surgery were sinonasal (36 of 60, 60%) resolving in all but two.
ETSS for GH adenomas is associated with high rates of remission and a low incidence of new endocrinopathy. Despite the panoramic views offered by the endoscope, invasive tumors continue to have lower rates of remission.
尽管内镜经鼻蝶窦手术（ETSS）的应用日益广泛，但生长激素腺瘤的治疗效果仍不明确。
我们回顾了经 ETSS 治疗的经验，特别关注采用 2010 年共识标准的缓解率、缓解的预测因素以及相关并发症。
这是一项回顾性单中心研究。
患者、干预措施和结果测量：共确定了 60 例肢端肥大症患者接受了 ETSS。缓解定义为 IGF-I 正常，口服葡萄糖耐量试验时 GH 低于 0.4ng/ml 或随机 GH 低于 1.0ng/ml。
14 例微腺瘤和 46 例大腺瘤中的 28 例（61%）达到缓解。肿瘤大小、年龄、性别和既往手术史在多变量分析中无预测意义。术后住院期间清晨 GH 水平低于 2.5ng/ml 对缓解的预测最佳（P<0.001）。术前预测缓解的变量包括 Knosp 评分（P=0.017）、IGF-I（P=0.030）和 GH（P=0.042）水平。新发内分泌功能障碍包括 5%的尿崩症、5.4%的肾上腺皮质功能不全和 29%的男性和 17%的女性新发性性腺功能减退。然而，41%的性腺功能减退男性术后睾酮水平正常，83%的闭经女性恢复月经。术后最常见的症状是鼻-鼻窦（60 例中有 36 例，占 60%），但除 2 例外均缓解。
ETSS 治疗生长激素腺瘤的缓解率高，新发内分泌功能障碍发生率低。尽管内镜提供了全景视野，但侵袭性肿瘤的缓解率仍较低。
