Retrospective analysis of long-term surgical results in acromegaly: preoperative and postoperative factors predicting outcome.
OBJECTIVE
Sixty-one of 83 patients with acromegaly treated between 1969 and 1993 were analysed retrospectively to clarify which early postoperative factors were significant predictors of a successful long-term outcome and which preoperative factors significantly influenced the early postoperative results.


METHODS
Of the 61 patients, 30 were operated on before 1987 and 31 afterwards. A successful long-term surgical outcome was defined as a long-term mean basal GH level < 6 mU/l (comparable to < 3 micrograms/l), a normal IGF-I level, and normal GH dynamics.


RESULTS
Overall, 59% of patients (37% before 1987 and 81% after) had an early postoperative mean basal GH level < 6 mU/l, and 56% (29% before 1987 and 77% after) met all three of the specified criteria for a successful long-term surgical outcome. Statistical analysis confirmed that GH dynamics and postoperative mean basal GH level < 6 mU/l were significant predictors of the long-term surgical outcome, whereas the postoperative IGF-I level alone was not. On the other hand, abnormal preoperative GH dynamics were normalized in all patients with a postoperative mean basal level < 6 mU/l. In addition, there were no patients showing an unsuccessful long-term outcome in those associated with both the early postoperative mean basal GH level < 6 mU/l and normalization of the IGF-I level. Therefore, measurement of the early postoperative mean basal GH level and the IGF-I level may be an economical and simple guide to predict the long-term surgical outcome. Moreover, multivariate analysis indicated that cavernous sinus invasion was an independent significant factor influencing the early postoperative outcome.


CONCLUSIONS
Successful long-term surgical outcome may be predicted if early postoperative mean basal GH level is reduced to < 6 mU/l (< 3 micrograms/l) and IGF-I level becomes normal. This study also confirms that early diagnosis and treatment by an experienced endocrinologist and neurosurgeon can improve the operative results in patients with acromegaly.
Yamada
S
S
Department of Neurosurgery, Toranomon General Hospital, Tokyo, Japan.
Aiba
T
T
Takada
K
K
Ozawa
Y
Y
Shimizu
T
T
Sawano
S
S
Shishiba
Y
Y
Sano
T
T
D000172:Acromegaly / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D005260:Female; D013006:Growth Hormone / Q000097:blood / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D015999:Multivariate Analysis; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone