title: [Outcome of surgical treatment for acromegaly performed by a single neurosurgeon and cumulative meta-analysis].
abstract: The aim of this retrospective study was to evaluate the results of transsphenoidal surgery in a group of patients with acromegaly who were operated by the same neurosurgeon. Our results were compared to those from a cumulative meta-analysis of 10 series (1,632 patients) published between 1992 and 2005. We followed 28 patients (17M/11F; 44.1 +/- 12.7 yr; 27 with macroadenomas; 86% being invasive) during 21.4 +/- 17.6 months after treatment. Patients were classified according to disease activity as follows: 1) controlled (CD): basal or mean GH < 2.5 ng/ml or nadir GH (OGTT) < 1 ng/ml and normal IGF-1; 2) uncontrolled (UCD): basal or mean GH > 2.5 ng/ml or nadir GH > 1 ng/ml and elevated IGF-1; 3) inadequately controlled (ICD): normal GH and elevated IGF-1 or elevated GH and normal IGF-1. After surgery, GH levels decreased from 61.7 +/- 101.1 ng/ml to 7.2 +/- 13.7 ng/ml (p< 0.001) and mean IGF-1 from 673.1 +/- 257.7 ng/ml to 471.2 +/- 285 ng/ml (p= 0.01). Biochemical remission rate was 57% [10 (35.5%) patients with CD and 6 (21.5%) with ICD], similar to the mean remission rate observed in the meta-analysis of surgical outcome of macroadenomas. Seven of 28 patients were submitted to surgical re-intervention (4 had been previously operated elsewhere and 3 by our neurosurgeon), with CD observed in 5 (71.5%) on follow-up. Cavernous sinuses invasion was more prevalent in UCD and ICD, whereas infundibular stalk deviation occurred only in patients with UCD. Remission rate was significantly higher in series where all surgical procedures were performed by the same surgeon (66% vs. 49%; p< 0.05). Thus, the surgeon's experience significantly improves the surgical outcome in acromegaly, especially in patients harboring large and invasive tumors, and re-intervention performed by an experienced surgeon should be considered in the algorithms for clinical management of this disease.
authors.affiliation: Serviço de Endocrinologia e Metabologia, Hospital de Clínicas, Universidade Federal do Paraná.
authors.forename: Anke
authors.initials: A
authors.lastname: Boeving
authors.forename: Luiz Alencar
authors.initials: LA
authors.lastname: Borba
authors.forename: Adriane Maria
authors.initials: AM
authors.lastname: Rodrigues
authors.forename: Elisa Brunner
authors.initials: EB
authors.lastname: Orichowski
authors.forename: Gilberto Jorge da
authors.initials: GJ
authors.lastname: Paz Filho
authors.forename: Carlos M Correa Dos
authors.initials: CM
authors.lastname: Santos
authors.forename: César Luiz
authors.initials: CL
authors.lastname: Boguszewski
mesh_terms: D000172:Acromegaly / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D004812:Epidemiologic Methods; D005260:Female; D005951:Glucose Tolerance Test; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D019382:Human Growth Hormone / Q000097:blood / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D019635:Neurosurgical Procedures / Q000592:standards*; D012074:Remission Induction; D013100:Sphenoid Bone; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I