<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_inj-2017-0004_s_006_w2aab3b7b3b1b6b1aab1c16b1Aa"><h3>Purpose</h3><p>Acromegaly is an unusual disorder caused by abnormal oversecretion of growth hormone by pituitary adenomas. Transsphenoidal surgery is frequently the first management option. The objective of this article is to establish the effectiveness of a transnasal transsphenoidal approach in the treatment of GH-producing adenomas, and to identify risk factors for disease persistence.</p></sec><sec id="j_inj-2017-0004_s_007_w2aab3b7b3b1b6b1aab1c16b2Aa"><h3>Methods</h3><p>We conducted a retrospective review of 81 patients treated for acromegaly with transsphenoidal microsurgery between 2006 and 2010.</p></sec><sec id="j_inj-2017-0004_s_008_w2aab3b7b3b1b6b1aab1c16b3Aa"><h3>Results</h3><p>Macroadenomas accounted for 66.7% of the cases, contrast-enhanced MRI revealing cavernous sinus invasion in 28.4% of the patients (23 subjects). Cure was achieved in 72.8% (59 of 82). All microadenomas (27 cases) were managed effectively with surgery whereas cure rates stood at 66.7% for macroadenomas. Monovariate analysis showed that disease persistence was statistically associated with three variables. Odds ratio for remission stood at 1.68 for microadenomas and 0.033 for cavernous sinus invasion (p&lt;0.001). Preoperative GH values were statistically associated with cure during follow up (p&lt;0.05). Multivariate logistic regression analysis showed that only cavernous sinus invasion continued to be significantly associated with disease persistence (OR 3.52, p&lt;0.05).</p></sec><sec id="j_inj-2017-0004_s_009_w2aab3b7b3b1b6b1aab1c16b4Aa"><h3>Conclusion</h3><p>The transnasal approach proves effective in the treatment and cure of acromegaly. Cavernous sinus invasion is a major predictor of disease persistence.</p></sec></abstract>

PurposeAcromegaly is an unusual disorder caused by abnormal oversecretion of growth hormone by pituitary adenomas. Transsphenoidal surgery is frequently the first management option. The objective of this article is to establish the effectiveness of a transnasal transsphenoidal approach in the treatment of GH-producing adenomas, and to identify risk factors for disease persistence.MethodsWe conducted a retrospective review of 81 patients treated for acromegaly with transsphenoidal microsurgery between 2006 and 2010.ResultsMacroadenomas accounted for 66.7% of the cases, contrast-enhanced MRI revealing cavernous sinus invasion in 28.4% of the patients (23 subjects). Cure was achieved in 72.8% (59 of 82). All microadenomas (27 cases) were managed effectively with surgery whereas cure rates stood at 66.7% for macroadenomas. Monovariate analysis showed that disease persistence was statistically associated with three variables. Odds ratio for remission stood at 1.68 for microadenomas and 0.033 for cavernous sinus invasion (p<0.001). Preoperative GH values were statistically associated with cure during follow up (p<0.05). Multivariate logistic regression analysis showed that only cavernous sinus invasion continued to be significantly associated with disease persistence (OR 3.52, p<0.05).ConclusionThe transnasal approach proves effective in the treatment and cure of acromegaly. Cavernous sinus invasion is a major predictor of disease persistence.

Early Results of Microsurgical Treatment of Acromegaly

International Neuroscience Journal

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"Early Results of Microsurgical Treatment of Acromegaly"}

PurposeAcromegaly is an unusual disorder caused by abnormal oversecretion of growth hormone by pituitary adenomas. Transsphenoidal surgery is frequently the...

References	Number of patients	Remission percentage (%)	Predictors of persistent disease based on multivariable analysis
Minniti et al.	92	55	Cavernous sinus invasion Size
Attanasio et al.	96	63,5	None
Kreutzer et al.	57	70,2	Dural invasion
Bourdelot et al.	83	59	Size >15 mm
van Bunderen et al.	30	30	Cavernous sinus invasion
Present series	81	72,8	Cavernous sinus invasion

	Biochemical control	Persistent disease
Females+	26/59 (44%)	8/14 (57%)	P=0,39 Fisher Exact Test
Age mean±satandard deviation	43,03±16,2	36,68±9,42	P=0,24 Student T test
Cavernouse sinus invasión	6/59 (10%)	17/22(77%)	p<0,001 Fisher Exact Test
Microadenoma	28/59 (47%)	0/22 (0%)	p<0,001 Fisher Exact Test
Preoperative GH median±interqartile range (mU/ml)⁺	18,35±16,2	8,5±6,8	p<0,05 Mac Niemann
Preoperative IGF-1 median±interqartile range (ng/ml)⁺	842±277	805±460	P=0,37 Mac Niemann

Early Results of Microsurgical Treatment of Acromegaly

Article Category: Research Article

Publié en ligne: 02 juin 2018

Pages: 22 - 29

DOI: https://doi.org/10.1515/inj-2017-0004

Mots clés
acromegaly, transsphenoidal approach, pituitary adenoma

© 2017 Pablo Ajler et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Figure 1

Figure 2

Predictors of persistent disease in published series from 2000 onwards. Only series with a multivariate analysis which used a microsurgical technique are included into the table.

Comparison of preoperative characteristics between patients cured after surgery and patients with persistent disease

Early Results of Microsurgical Treatment of Acromegaly

Article Category: Research Article

Publié en ligne: 02 juin 2018

Pages: 22 - 29

DOI: https://doi.org/10.1515/inj-2017-0004

Mots clésacromegaly, transsphenoidal approach, pituitary adenoma

© 2017 Pablo Ajler et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Figure 1

Figure 2

Predictors of persistent disease in published series from 2000 onwards. Only series with a multivariate analysis which used a microsurgical technique are included into the table.

Comparison of preoperative characteristics between patients cured after surgery and patients with persistent disease

Mots clés
acromegaly, transsphenoidal approach, pituitary adenoma