title: Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma.
abstract: OBJECTIVE
  Transsphenoidal pituitary surgery (TS) is the primary treatment of choice for patients with acromegaly. Macroadenomas (>1 cm) are more difficult to resect than microadenomas (remission rate ± 50% compared to ± 90%). Besides the conventional microscopic TS, the more recently introduced endoscopic technique is nowadays frequently used. However, no large series reporting on its results have yet been published. We evaluated the outcome of endoscopic TS in 40 patients with a growth hormone (GH)-secreting macroadenoma treated in our hospital between 1998 and 2007.
  
  
  METHODS
  Medical records were retrospectively reviewed. Remission was defined as disappearance of clinical symptoms of acromegaly, normal serum insulin-like growth factor-1 levels (≤2 SD) and serum GH levels suppressed to <2 mU/l after an oral glucose tolerance test within the first 4 months after TS.
  
  
  RESULTS
  In four patients TS aimed at debulking of the tumour. In the remaining 36 patients, remission was achieved in 20 patients. In the first 5 years remission was achieved in 6 out of 18 patients (33%) compared to 14 out of 22 patients (63%) in the following 5 years (p = 0.06). Thirteen patients had a mild perioperative complication. Before TS 15 patients received hormonal substitution therapy compared to 12 patients (33%) after TS.
  
  
  CONCLUSIONS
  Endoscopic TS is a good primary therapeutic option for patients with a GH-secreting macroadenoma, resulting in a remission rate of up to 63% in experienced hands. This technique can potentially improve the outcome of TS in these patients.
authors.affiliation: Pituitary Centre Nijmegen, Department of Endocrinology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands. m.wagenmakers@endo.umcn.nl
authors.forename: Margreet Albertina E M
authors.initials: MA
authors.lastname: Wagenmakers
authors.forename: Romana T
authors.initials: RT
authors.lastname: Netea-Maier
authors.forename: Erik J
authors.initials: EJ
authors.lastname: van Lindert
authors.forename: Gerlach F F M
authors.initials: GF
authors.lastname: Pieters
authors.forename: André J A
authors.initials: AJ
authors.lastname: Grotenhuis
authors.forename: Ad R M M
authors.initials: AR
authors.lastname: Hermus
mesh_terms: D000172:Acromegaly / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007016:Hypophysectomy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult