title: Assessment of long-term remission of acromegaly following surgery.
abstract: OBJECTIVE
  The criteria for remission of acromegaly following transsphenoidal adenoma resection are in evolution. In the present study the authors evaluate the utility of predicting long-term remission by reference to a single fasting growth hormone (GH) level on the 1st postoperative day.
  
  
  METHODS
  A retrospective analysis was conducted on 181 patients with acromegaly who underwent transsphenoidal resection between 1973 and 1990 and completed a 5-year follow-up period. Fasting serum GH levels were obtained in all patients on the 1st postoperative day in the absence of exogenous glucocorticoids. All patients participated in a follow-up evaluation lasting at least 5 years, which included measurements of serum insulin-like growth factor-I (IGF-I) levels as an index of acromegalic activity. Among the 181 patients, GH levels ranged from 0 to 8 ng/ml in 131 (72%) on the 1st postoperative day, suggesting biochemical remission. This group included 107 (84%) of the 127 patients with microadenomas, but only 24 (44%) of the 54 with macroadenomas. Nevertheless, 15 (11%) of the 131 patients who initially had attenuated GH levels displayed recurrent acromegaly within the first 2 years (with elevated levels of IGF-I in all cases, and abnormalities appearing on magnetic resonance images in nine cases). Only one of 116 patients in whom the initial postoperative GH level was lower than 2 ng/ml experienced a recurrence, whereas 14 (93%) of the 15 patients with postoperative GH levels between 2.2 and 8 ng/ml subsequently displayed biochemical evidence of acromegaly.
  
  
  CONCLUSIONS
  The findings indicate that a fasting morning serum GH level lower than 2 ng/ml on the 1st postoperative day portends long-term biochemical remission of acromegaly, whereas higher levels are a significant marker for recurrent disease.
authors.affiliation: Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Krieger
authors.forename: William T
authors.initials: WT
authors.lastname: Couldwell
authors.forename: Martin H
authors.initials: MH
authors.lastname: Weiss
mesh_terms: D000172:Acromegaly / Q000175:diagnosis* / Q000209:etiology*; D000236:Adenoma / Q000378:metabolism / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002648:Child; D003399:Craniotomy / Q000379:methods; D005260:Female; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000601:surgery*; D011184:Postoperative Period; D012074:Remission Induction; D012189:Retrospective Studies; D013100:Sphenoid Bone
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I