Neurosurgery department, CHU Timone, Aix-Marseille university, AP-HM, Marseille, France; Inserm, MMG, Aix-Marseille university, Marseille, France.
Inserm, MMG, Aix-Marseille university, Marseille, France; Endocrinology department, CHU Conception, Aix-Marseille university, AP-HM, Marseille, France.
Ann Endocrinol (Paris). 2020 Feb;81(1):11-17. doi: 10.1016/j.ando.2019.11.002. Epub 2019 Dec 19.
The aim of this study was to describe endocrinological outcome in patients operated on for acromegaly.
A retrospective study included 167 patients. Patients were assessed in the early postoperative period (EPP), at 3 months (M3), at 1 year (Y1), and then annually. They were classified as grade I (IGF-1 level normal-for-age and positive GH response on oral glucose tolerance test [nadir <0.4ng/L]); grade II (discordant); or grade III or IV (acromegaly, controlled or uncontrolled under medical therapy, respectively).
Taking all patients with all grades, 35% changed grades between EPP and M3, 26% between M3 and Y1 and 9% after Y1. In grade I, respectively 22%, 15% and 2% of patients changed grades between EPP and M3, between M3 and Y1, and after Y1, compared to 31%, 6% and 6% in grade IV. Respectively 57%, 67%, and 47% of grade II patients changed grades between EPP and M3, between M3 and Y1, and after Y1; between EPP or M3 and last follow-up (>1 year), respectively 74% and 75% of grade II patients changed grades. Knosp category, resection quality and abnormal GH response (vs. abnormal IGF-1) significantly impacted grade II patients' outcome.
Whereas outcome in grades I and III-IV seems to be determined by 1 year, grade II discordant patients' outcome remains uncertain even after 1 year.
本研究旨在描述接受手术治疗的肢端肥大症患者的内分泌学结果。
回顾性研究纳入 167 例患者。患者在术后早期（EPP）、术后 3 个月（M3）、术后 1 年（Y1）进行评估，然后每年评估一次。他们被分为 I 级（IGF-1 水平正常年龄，口服葡萄糖耐量试验时 GH 反应阳性[谷值<0.4ng/L]）、II 级（不一致）或 III 级或 IV 级（肢端肥大症，分别为药物治疗控制或未控制）。
对于所有 I 级和所有 III-IV 级患者，EPP 与 M3 之间、M3 与 Y1 之间以及 Y1 后，分别有 35%、26%和 9%的患者改变了分级。在 I 级中，EPP 与 M3 之间、M3 与 Y1 之间和 Y1 后，分别有 22%、15%和 2%的患者改变了分级，而 IV 级分别有 31%、6%和 6%。在 II 级中，EPP 与 M3 之间、M3 与 Y1 之间和 Y1 后，分别有 57%、67%和 47%的患者改变了分级；EPP 或 M3 与末次随访（>1 年）之间，分别有 74%和 75%的 II 级患者改变了分级。Knosp 分级、切除质量和异常 GH 反应（与异常 IGF-1 相比）显著影响了 II 级患者的结局。
虽然 I 级和 III-IV 级的结局似乎在 1 年内确定，但 II 级不一致患者的结局在 1 年后仍不确定。
