Department of Neurosurgery, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla;
J Neurosurg. 2013 Dec;119(6):1467-77. doi: 10.3171/2013.8.JNS13224. Epub 2013 Sep 27.
Acromegaly is a disease that has significant morbidity and mortality related to high levels of growth hormone (GH) and insulin-like growth factor-I (IGF-I), and is usually caused by pituitary adenomas. The goal in this study was to investigate the role of endoscopic transsphenoidal surgery and surgical experience in the treatment of GH adenoma cases in relation to surgical results and hormonal cure rates, and to perform a review of the literature.
The authors present a retrospective analysis of 214 GH adenoma cases. Restoration of IGF-I levels to normal for age and sex, suppression of GH levels below 0.4 μg/L on the oral glucose tolerance test, and demonstration of the total removal of the tumor on MRI studies obtained after administration of contrast material at the 3-month postoperative follow-up visit were the criteria for cure.
In total 214 patients with a mean age of 41.9 ± 12 years (range 17-75 years) and a male/female ratio of 106/108 were enrolled in the study. Cure was achieved in 134 (62.6%) of 214 patients. One hundred sixty-nine patients were primary cases, and of these 109 (64.5%) were cured, whereas 61 patients were previously operated cases and of these 25 (41%) were cured. With a 51.1% decrease in the 1st month postoperatively, IGF-I levels were found to be predictive of cure (74.4% sensitivity and 73.7% specificity). Cut-off values for GH levels in predicting cure for the 1st day, 1st week, and 1st month postoperatively were 2.33, 2.05, and 2.25 μg/L, respectively. The cut-off value for surgical experience was 57 for primary surgeries (58.5% cure rate before this cut-off value compared with 72.6% after it; p = 0.025) and 108 for all operations (45.8% vs. 79.4%, p = 0.037). Although 28 patients were found to be in remission according to the criteria in 2000, they were not in remission according to the new consensus criteria. Nine of these cases (32.1%) had random GH levels < 1 μg/L at the 1-year follow-up. The 1-year IGF-I and GH levels in these 28 patients showed no significant difference when compared with the cases defined as cured according to the current criteria.
In acromegaly treatment, transsphenoidal endoscopic surgery performed by an expert senior surgeon and increased surgical experience are important for higher cure rates. Random GH levels < 2.33 μg/L after the 1st day postoperatively and a > 50% decrease in IGF-I levels after the 1st month postoperatively are predictive of cure. Moreover, there is no urgency for additional therapy in patients with GH levels of 0.4-1 μg/L and MRI sequences showing no tumor at the 3-month follow-up, because for these cases remission can be achieved at the 1-year follow-up.
肢端肥大症是一种与生长激素（GH）和胰岛素样生长因子-I（IGF-I）水平升高相关的具有显著发病率和死亡率的疾病，通常由垂体腺瘤引起。本研究旨在探讨内镜经蝶窦手术和手术经验在与手术结果和激素治愈率相关的 GH 腺瘤病例治疗中的作用，并对文献进行回顾。
作者对 214 例 GH 腺瘤病例进行了回顾性分析。将 IGF-I 水平恢复到年龄和性别正常、口服葡萄糖耐量试验时 GH 水平抑制到 0.4μg/L 以下、以及在术后 3 个月磁共振成像（MRI）检查时给予造影剂后显示肿瘤完全切除，作为治愈的标准。
共有 214 例平均年龄为 41.9±12 岁（17-75 岁）的患者和男女比例为 106/108 的患者入组。214 例患者中 134 例（62.6%）治愈。169 例为原发性病例，其中 109 例（64.5%）治愈，61 例为既往手术病例，其中 25 例（41%）治愈。术后第 1 个月 IGF-I 水平下降 51.1%，可预测治愈（74.4%的敏感性和 73.7%的特异性）。预测第 1 天、第 1 周和第 1 个月术后治愈的 GH 水平的临界值分别为 2.33、2.05 和 2.25μg/L。手术经验的临界值为 57 例（58.5%在该临界值之前，72.6%在该临界值之后治愈；p=0.025）和 108 例（45.8%与 79.4%，p=0.037）所有手术。尽管根据 2000 年的标准，28 例患者被认为处于缓解状态，但根据新的共识标准，他们并未处于缓解状态。这些病例中有 9 例（32.1%）在 1 年随访时随机 GH 水平<1μg/L。这些 28 例患者的 1 年 IGF-I 和 GH 水平与根据当前标准定义的治愈病例无显著差异。
在肢端肥大症的治疗中，由经验丰富的高级外科医生进行的经蝶窦内镜手术和增加手术经验对于提高治愈率非常重要。术后第 1 天随机 GH 水平<2.33μg/L 和术后第 1 个月 IGF-I 水平下降>50%可预测治愈。此外，在术后 3 个月 MRI 序列无肿瘤且 GH 水平为 0.4-1μg/L 的患者中，无需进行额外治疗，因为这些患者在 1 年随访时可达到缓解。
