Recurrence following transsphenoidal surgery for acromegaly.
The long-term results of transsphenoidal adenomectomy and the incidence of possible recurrences were studied in 61 patients who had normal basal serum growth hormone (GH) levels 1 week after surgery. The patients were followed up for an average of 6.0 years (range: 1.5-14.0 years) by repeated measurements of GH, oral glucose tolerance testing (OGTT) and at the last follow-up visit also by assaying somatomedin C levels. In 4 of the patients, the basal GH levels had increased to values above 5 ng/ml. In 43 patients, a normal suppression of GH during an oral glucose load was observed shortly after surgery. In only 2 of these cases did a transiently inadequate suppression develop during the follow-up period, although clinical acromegaly did not recur and the somatomedin C levels remained normal. It is concluded that recurrence of active acromegaly is unlikely to occur in patients who achieve a normal glucose-induced suppression of GH levels shortly after adenomectomy. As such, an OGTT provides better prognostic information than basal human GH level measurements and may give a clearer and earlier indication of surgical success.
Buchfelder
M
M
Neurochirurgische Klinik, Universität Erlangen-Nürnberg, FRG.
Brockmeier
S
S
Fahlbusch
R
R
Honegger
J
J
Pichl
J
J
Manzl
M
M
D000172:Acromegaly / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010902:Pituitary Gland / Q000000981:diagnostic imaging / Q000473:pathology; D010911:Pituitary Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone