Tsiberkin A I, Tsoy U A, Cherebillo V Yu, Polezhaev A V, Gussarova N V, Grineva E N
Almazov National Medical Research Center, St. Petersburg, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2019;83(1):98-104. doi: 10.17116/neiro20198301198.
For a long time, surgical removal of somatotropinoma using the transsphenoidal approach has been the first stage of treatment in most acromegaly patients. For the past decades, the efficacy criteria for surgical treatment of acromegaly have significantly changed, which requires appropriate correction.
We aimed to evaluate the results of transsphenoidal adenomectomy in acromegaly patients using various criteria for disease remission.
The study included patients with newly diagnosed acromegaly who underwent transnasal transsphenoidal endoscopic adenomectomy performed by a single neurosurgeon. The surgical treatment outcomes were evaluated 6 months after operative intervention based on levels of IGF-1, OGTT, and GH. The obtained data were analyzed using different threshold values for the level of GH nadir during OGTT: criteria A <2.0 ng/ml, criteria B <1.0 ng/ml, and criteria C <0.4 ng/ml to assess acromegaly remission, along with matching of the IGF-1 level to the reference range for a given gender and age.
The study included 70 patients (52 females and 18 males) with a mean age of 52.2±11.5 years (29 to 73 years). The baseline IGF-1 level exceeded the upper limit of the reference range 3.3±1.4 (1.1-7.3)-fold, on average. The baseline mean basal GH level was 34.2±41.7 (1.2-192.0) ng/ml. The mean pituitary adenoma size was 16.7±8.6 (4.3-46.0) mm; 18 (26%) out of 70 patients had pituitary microadenoma, and 52 (74%) patients had macroadenoma. Six months after surgery, acromegaly remission met criteria A in 47 (67%) patients, criteria B in 28 (40%) patients, and criteria C in 18 (26%) patients.
Our findings demonstrate that evaluation of transsphenoidal adenomectomy outcomes in treatment of acromegaly patients depends on the criteria chosen for assessing remission. This feature should be considered when comparing outcomes of surgical treatment for acromegaly in different years. Probably, introduction of the 2010 criteria should be accompanied by revision of the previous remission indicators.
长期以来，经蝶窦入路手术切除生长激素瘤一直是大多数肢端肥大症患者的首选治疗阶段。在过去几十年中，肢端肥大症手术治疗的疗效标准发生了显著变化，这需要进行适当的修正。
我们旨在使用各种疾病缓解标准评估肢端肥大症患者经蝶窦腺瘤切除术的结果。
该研究纳入了新诊断为肢端肥大症且由单一神经外科医生进行经鼻经蝶窦内镜腺瘤切除术的患者。基于IGF-1、口服葡萄糖耐量试验（OGTT）和生长激素（GH）水平，在手术干预6个月后评估手术治疗结果。使用OGTT期间GH最低点水平的不同阈值分析获得的数据：标准A<2.0 ng/ml、标准B<1.0 ng/ml和标准C<0.4 ng/ml以评估肢端肥大症缓解情况，同时将IGF-1水平与给定性别和年龄的参考范围进行匹配。
该研究纳入了70例患者（52例女性和18例男性），平均年龄为52.2±11.5岁（29至73岁）。基线IGF-1水平平均超过参考范围上限3.3±1.4（1.1 - 7.3）倍。基线平均基础GH水平为34.2±41.7（1.2 - 192.0）ng/ml。垂体腺瘤平均大小为16.7±8.6（4.3 - 46.0）mm；70例患者中有18例（26%）患有垂体微腺瘤，52例（74%）患者患有大腺瘤。手术后6个月，47例（67%）患者的肢端肥大症缓解符合标准A，28例（40%）患者符合标准B，18例（26%）患者符合标准C。
我们的研究结果表明，评估肢端肥大症患者经蝶窦腺瘤切除术的结果取决于选择用于评估缓解的标准。在比较不同年份肢端肥大症手术治疗结果时应考虑这一特征。可能，引入2010年标准时应同时修订先前的缓解指标。
