Tsiberkin A I, Tsoy U A, Cherebillo V Y, Polezhaev A V, Kuritsyna N V, Paltsev A A, Alkhazishvili A V, Grineva E N
Almazov National Medical Research Center.
Ter Arkh. 2020 Nov 24;92(10):48-53. doi: 10.26442/00403660.2020.10.000490.
To investigate the value of 24 hours post-surgery measurement of growth hormone (GH) level for prognosis of surgical outcomes in acromegaly.
A prospective cohort study included 45 patients with newly diagnosed acromegaly. The degree of parasellar extension was measured on the preoperative sellar magnetic resonance imaging according to the Knosps classification. All patients underwent a transsphenoid adenomectomy performed by one neurosurgeon. Basal GH level was measured at 24 hours after surgery. The efficacy of transsphenoidal adenomectomy evaluated at 12 months after surgery.
Acromegaly remission was achieved in 19 (42%) of 45 patients at 12 months after surgery. Pituitary microadenomas and the absence of paracellular invasion, corresponding to Knosp Grade 02, had low prognostic value for long-term remission due to low sensitivity (31.6%) and low specificity (38.5%), respectively. The highest prognostic value for acromegaly remission was showed for 24 hours post-surgery GH level with cut-off 1.30 ng/ml with sensitivity of 96.2% (95% confidence interval 81.199.8%) and specificity of 84.2% (95% confidence interval 62.494.4%).
The study demonstrated the possibility of using GH level at 24 after surgery as a predictor for acromegaly remission. GH level 1.30 ng/ml at 24 hours after surgery showed better predictive value for long-term remission compared with the presence of microadenomas and Knosp Grade 02. The absence of decrease of GH level on the first day after surgery may serve as a reason for more close monitoring of patients in the postoperative period. Further studies in a larger number of observers are required to confirm our findings.
探讨术后24小时生长激素（GH）水平对肢端肥大症手术预后的评估价值。
一项前瞻性队列研究纳入了45例新诊断的肢端肥大症患者。术前蝶鞍磁共振成像根据Knosps分类法测量鞍旁扩展程度。所有患者均由一名神经外科医生实施经蝶窦腺瘤切除术。术后24小时测量基础GH水平。术后12个月评估经蝶窦腺瘤切除术的疗效。
45例患者中，19例（42%）在术后12个月实现肢端肥大症缓解。垂体微腺瘤以及无鞍旁侵犯（对应Knosps 0-2级）对长期缓解的预后价值较低，敏感性分别为31.6%，特异性分别为38.5%。术后24小时GH水平对肢端肥大症缓解的预后价值最高，临界值为1.30 ng/ml，敏感性为96.2%（95%置信区间81.1%-99.8%），特异性为84.2%（95%置信区间62.4%-94.4%）。
本研究表明术后24小时GH水平可作为肢端肥大症缓解的预测指标。与垂体微腺瘤和Knosps 0-2级相比，术后24小时GH水平为1.30 ng/ml对长期缓解具有更好的预测价值。术后第一天GH水平未下降可能是术后对患者进行更密切监测的原因。需要更多观察者参与的进一步研究来证实我们的发现。
