Surgical treatment and clinical outcome of GH-secreting adenomas in elderly patients.
Patients older than 65 years represent 3-5% of all acromegalic patients. The old age of the patients and the higher incidence of cardiovascular and metabolic complications related to acromegaly could increase the intra- and peri-operative risk, so that medical treatment is usually recommended as a therapy of choice. The aim of this retrospective study was to investigate the impact of transsphenoidal surgery in a series of 22 elderly patients with active acromegaly, with special regard to anaesthesiological risk, peri-operative complications, and clinical outcome. Despite an increased anesthesiological risk being present in 16/22 patients, no complication occurred during surgery. Similarly, no post-operative mortality or major complications were observed. Biochemical cure, defined at 6 months by glucose-suppressed plasma GH levels below 1 ng/ml and normal age-corrected IGF-I value levels, was achieved in 68% of patients and no recurrence of disease was observed in the subsequent follow-up (mean 5.2+/-2.1 years). A significant cardiovascular improvement was observed in cured patients, with a decrease of left ventricular mass index (91.3+/-20.1 vs 115.9+/-15.0 g/m(2); P<0.005), as measured by echocardiography, as well as a slight but significant decrease of systolic and diastolic blood pressure values (130.0+/-12.1 mmHg vs 137.6+/-13.5 mmHg P<0.05; and 84.2+/-6.4 mmHg vs 88.8+/-7.5 mmHg P<0.05, respectively). A significant post-operative improvement of glucose tolerance was also observed in this group. We conclude that transsphenoidal surgery, if well planned and carefully performed, is safe and able to induce a significant cardiovascular and metabolic improvement even in elderly acromegalic patients.
Minniti
G
G
Division of Neurosurgery, IRCCS NEUROMED University of Rome, Pozzilli, Italy.
Jaffrain-Rea
M L
ML
Esposito
V
V
Santoro
A
A
Moroni
C
C
Lenzi
J
J
Tamburrano
G
G
Cassone
R
R
Cantore
G
G
D000172:Acromegaly / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D005947:Glucose / Q000378:metabolism; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D008297:Male; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D019382:Human Growth Hormone; D005947:Glucose