The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'.
OBJECTIVE
The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH-secreting adenomas, and to compare the results concerning control of disease with previous series using older criteria of cure.


METHODS
We report on a consecutive series of 688 acromegalic patients treated over a time period of 19 years. Biochemical cure was defined as normalisation of basal GH level, suppression of GH levels to below 1 ng/ml during an oral glucose load and normalisation of IGF-I levels. Of the 506 patients undergoing primary transsphenoidal surgery, a total of 57.3% postoperatively fulfilled the criteria used.


RESULTS
The rate of biochemical 'cure' correlated with the magnitude of the initial GH levels, the tumour size and invasion. The overall complication rate was below 2%. Mortality in this series was 0.1% (1 of 688). During a follow-up period of 10.7 years only two recurrences (0.4%) occurred. However, in the patients treated by transcranial surgery and by repeat surgery the cure rate was found to be relatively low (5.2 and 21.3% respectively).


CONCLUSIONS
These data suggest that surgery remains with very few exceptions the primary treatment of acromegaly for (i) a high cure rate, (ii) low morbidity, (iii) low recurrence rate and (iv) immediate decline of GH. Based on current criteria of cure, recurrences are uncommon. However, cure by surgery alone is improbable in patients harbouring extended, invasive tumours with high secretory activity, in whom further adjuvant treatment is mandatory.
Nomikos
Panagiotis
P
Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany. nomikosp@otenet.gr
Buchfelder
Michael
M
Fahlbusch
Rudolf
R
D000172:Acromegaly / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D000236:Adenoma / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000008:administration & dosage; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D015994:Incidence; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010902:Pituitary Gland / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011184:Postoperative Period; D012074:Remission Induction; D012086:Reoperation; D016896:Treatment Outcome
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D005947:Glucose