Diagnostic features and outcome of surgical therapy of acromegalic patients: experience of the last three decades.
OBJECTIVE
Transsphenoidal (TNS) surgery remains the primary therapeutic option for GH-secreting pituitary adenomas. The aims of this study were to verify the impact of TNS surgery on treatment of acromegaly before and after identification by a dedicated neurosurgical team and to enumerate diagnostic features of the disease described over three decades.


METHODS
41 patients (group A) who underwent TNS surgery by a dedicated neurosurgical team (2000-2008) and 126 patients (group B) operated on by surgeons not specialized in pituitary surgery (1979-1999) were retrospectively analyzed.


RESULTS
No significant differences were observed between the two groups in terms of delay of diagnosis, mean basal GH levels and GH nadir values, prevalence of hypopituitarism and hypertension. IGF-I SDS were significantly higher, while prevalence of IGT/diabetes was significantly lower in group B than in group A. Overall remission rate after surgery was 58.5% for group A (75% in microadenomas and 48% in macroadenomas, P=NS) and 37% for group B (P<0.05 vs group A; for microadenomas, 34% vs 75% of group A, P<0.05, for macroadenomas, 36% vs 48% of group A, P=NS). The mean delay of diagnosis was 4.9 and 5.9 years in group A and B, respectively.


CONCLUSIONS
Our data confirm that a dedicated neurosurgical team is needed in order to improve remission rates in acromegalic patients. No changes in biochemical, clinical and neuroradiological presentation of disease were observed over the last three decades. As the high prevalence of macroadenomas negatively influences surgical cure, earlier diagnosis should be considered as mandatory to achieve a better outcome.
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Elisa
E
Sala
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Emanuele
E
Ferrante
Unit of Neurosurgery, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Marco
M
Locatelli
Unit of Neurosurgery, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Paolo
P
Rampini
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Giovanna
G
Mantovani
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Claudia
C
Giavoli
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Marcello
M
Filopanti
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Elisa
E
Verrua
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Elenan
E
Malchiodi
Unit of Neurosurgery, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Giorgio
G
Carrabba
Department of Clinical Sciences and Community Health, University of Milan, Italy, Unit of Endocrine Diseases and Diabetology, San Giuseppe Hospital, Multimedica Group, Milan, Italy.
Maura
M
Arosio
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Paolo
P
Beck-Peccoz
Department of Clinical Sciences and Community Health, University of Milan; Endocrinology and Diabetology Unit, Fondazione IRCCS C Granda Ospedale Maggiore Policlinico, Milan, Italy.
Anna
A
Spada
BIOMETRA Department, University of Milan, IRCCS Istituto Clinico Humanitas, Rozzano; Italy.
Andrea Gerardo
AG
Lania
D000172:Acromegaly / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome