title: Outcome of surgical intrasellar growth hormone tumor performed by a pituitary specialist surgeon in a developing country.
abstract: BACKGROUND
  Acromegaly is an excessive GH secretion, which in most cases, is caused by a pituitary GH-secreting adenoma. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The aim of this retrospective study is to evaluate the results of transsphenoidal endoscopic surgery in a group of patients with intrasellar GH adenoma who were operated by a pituitary specialist surgeon. We shall then argue about the economical advantages, for the NHS of a developing country, between surgical and medical treatment.
  
  
  METHODS
  We have analyzed data from 33 patients with intrasellar GH tumor who had been referred to the neuroendocrine department of the HGF, Brazil. The patients underwent a transsphenoidal endoscopic adenomectomy for acromegaly between 2000 and 2005. Their ages were between 20 and 67 years (mean, 44 years) at the moment of surgery. No cavernous sinus invasion was present. Follow-up was a median of 2 years (range, 12 months-6 years).
  
  
  RESULTS
  All 33 patients had intrasellar adenoma, 84.84% of patients achieved remission by surgery. One patient was operated twice and reached hormonal normalization. Five patients still had the disease and refused a second surgery. A treatment with octreotide was started for these 5 patients and resulted in an adequate control of GH and IGF-1 levels. No patients had radiotherapy.
  
  
  CONCLUSIONS
  Our patients, with intrasellar GH tumor, operated by a pituitary specialist neurosurgeon had remission rates approaching those obtained by most specialized neurosurgical centers worldwide. For equal results, our study shows that the surgical treatment is the best issue for the patient and for the NHS.
authors.affiliation: Neurosurgical Department, General Hospital of Fortaleza, Brazil. jagondim@laposte.net
authors.forename: Jackson A
authors.initials: JA
authors.lastname: Gondim
authors.forename: Tania
authors.initials: T
authors.lastname: Ferraz
authors.forename: Italo
authors.initials: I
authors.lastname: Mota
authors.forename: Dayse
authors.initials: D
authors.lastname: Studart
authors.forename: João P C
authors.initials: JP
authors.lastname: Almeida
authors.forename: Erika
authors.initials: E
authors.lastname: Gomes
authors.forename: Michele
authors.initials: M
authors.lastname: Schops
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001938:Brazil; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004724:Endoscopy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D015282:Octreotide / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000379:methods; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013038:Specialization / Q000191:economics / Q000706:statistics & numerical data; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide