Evaluation of selective transsphenoidal adenomectomy by endocrinological testing and somatomedin-C measurement in acromegaly.
A series of 29 previously untreated patients with acromegaly underwent transsphenoidal adenomectomy. Pre- and postoperative evaluation consisted of measuring growth hormone (GH) secretory dynamics during an oral glucose tolerance test (OGTT), the insulin hypoglycemia test, and the thyrotropin- and gonadotropin-releasing hormone (TRH/GnRH) test, and by obtaining the basal somatomedin-C level. After surgery, clinical and biochemical amelioration was achieved in all but two patients. In the whole group, basal GH and somatomedin-C levels decreased from a mean (+/- standard error of the mean) of 52.3 +/- 12.7 to 11.1 +/- 6.3 ng/ml and from 7.6 +/- 0.7 to 2.5 +/- 0.5 U/ml, respectively. Application of different criteria of cure revealed that 19 patients (66%) had basal GH levels below 5 ng/ml, 17 patients (59%) had normal somatomedin-C values, 16 patients (55%) had complete GH suppression (less than 1 ng/ml) during OGTT, and 13 patients (45%) met the above-mentioned criteria with disappearance of the paradoxical GH response to TRH/GnRH test. Evaluation of GH secretion by insulin hypoglycemia testing was useless in assessing the outcome after neurosurgery. When only patients with a normal somatomedin-C level and complete GH suppressibility during OGTT were considered "cured," the main favorable prognostic factor was intrasellar tumor localization, since 15 (75%) of 20 patients were "cured," as opposed to only one (11%) of nine with extrasellar extension of the adenoma. During the follow-up period, no tumor recurrence was detected in any of the "cured" patients. In these subjects somatomedin-C levels remained stable in all except two patients, who showed a slow increase within the normal range of somatomedin-C concentration. These data confirm that transsphenoidal surgery is the most effective form of treatment in previously untreated acromegalic patients and that normalization of somatomedin-C levels reflects normal GH secretion. Measurement of somatomedin-C could replace more extensive endocrinological testing during monitoring of treated acromegalic patients.
Losa
M
M
Innenstadt Medical Clinic, University of Munich, West Germany.
Oeckler
R
R
Schopohl
J
J
Müller
O A
OA
Alba-Lopez
J
J
von Werder
K
K
D000172:Acromegaly / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D004702:Endocrine Glands / Q000503:physiopathology*; D005069:Evaluation Studies as Topic; D005260:Female; D005951:Glucose Tolerance Test; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011388:Prolactin / Q000097:blood; D012658:Sella Turcica; D013002:Somatomedins / Q000097:blood*; D013100:Sphenoid Bone / Q000601:surgery
D007328:Insulin; D013002:Somatomedins; D007334:Insulin-Like Growth Factor I; D011388:Prolactin; D013006:Growth Hormone