title: Improvement in remission rates of the first operation in acromegalic patients.
abstract: OBJECTIVE
  The aim of the study was to determine the remission rates of the first     operation with respect to the number of surgeons and the parameters important     for the prediction of the success.
  
  
  METHODS
  The study cohort     consisted of 180 acromegalic patients who presented over a 29 year. All the     patients had undergone transnasal transsphenoidal adenomectomy and then     octreotide treatment and/or radiotherapy were applied to the patients who were     not cured. Remission criteria was accepted as nadir GH < 1 μg/L with     oral glucose tolerance test (OGTT) and normal IGF-1 with respect to age and     gender.
  
  
  RESULTS
  The postoperative median follow up period was 84 months (range     6-372 months). The remission rate of the first operation before 2003 was 20%,     but this rate increased to 51% after 2003 (p=0.018). The most impressive     improvement was due to the single experienced surgeon (49% vs. 5.3%) (p <     0.001). The success of the first operation was determined by the tumor size,     microadenomas were more successfully treated than macroadenomas (p=0.014). The     prevalence of discordance between GH and IGF-1 was 24% in patients cured after     first surgery.
  
  
  CONCLUSIONS
  The clinical recognition of acromegaly and outcomes     of single experienced surgeons in specialized centers have significantly     improved over the last years.
authors.affiliation: Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey. dr.ozgurdemir@gmail.com
authors.forename: Ozgur
authors.initials: O
authors.lastname: Demir
authors.forename: Vedia
authors.initials: V
authors.lastname: Gedik
authors.forename: Demet
authors.initials: D
authors.lastname: Corapcioglu
authors.forename: Rifat
authors.initials: R
authors.lastname: Emral
authors.forename: Mustafa Agahan
authors.initials: MA
authors.lastname: Unlu
authors.forename: Murat Faik
authors.initials: MF
authors.lastname: Erdogan
authors.forename: Sevim
authors.initials: S
authors.lastname: Gullu
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Uysal
authors.forename: Nilgun
authors.initials: N
authors.lastname: Baskal
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000601:surgery*; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D005260:Female; D005951:Glucose Tolerance Test; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015282:Octreotide / Q000627:therapeutic use; D010902:Pituitary Gland / Q000601:surgery; D010907:Pituitary Hormones / Q000172:deficiency; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D010907:Pituitary Hormones; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide