title: Endocrinological outcomes following endoscopic and microscopic transsphenoidal surgery in 113 patients with acromegaly.
abstract: BACKGROUND
  To describe outcomes and complications in patients undergoing transsphenoidal surgery for acromegaly using the 2010 consensus criteria for biochemical remission.
  
  
  METHODS
  Retrospective review of 113 treatment naïve patients who underwent transsphenoidal surgery with the endoscopic (n=66) and the endonasal microscopic technique (n=47). Cure was defined if the age and sex-adjusted IGF-1 level was normal and either the basal GH was <1 ng/ml or the nadir GH was <0.4 ng/ml following oral glucose suppression at last follow-up.
  
  
  RESULTS
  The mean age at presentation was 38.1 ± 7.1 years and 86% of tumors were macroadenomas. Adenoma sizes averaged 21.1 ± 9.7 mm, but 56% of all tumors were ≥ 2 cm in size and 43.4% were invasive. Remission rates between endoscopic and microscopic transsphenoidal surgery did not differ significantly overall (28.8% versus 36.2%). On univariate analysis, a preoperative GH level <40 ng/ml, adenoma size <20mm and non-invasiveness were predictors of remission at follow-up. Although there were no statistically significant differences in remission rates between the endoscopic and microsurgical groups, surgically induced hypopituitarism was less frequent with the former.
  
  
  CONCLUSIONS
  We report our surgical experience with predominantly large, invasive GH adenomas using the 2010 criteria for cure. Patients with smaller, non-invasive tumors with lower preoperative GH levels are most likely to achieve remission. Outcomes with either the microscopic or endoscopic approach do not differ significantly, although the rate of surgically induced hypopituitarism may be higher with the former. Transsphenoidal surgery remains the first line of treatment for patients with acromegaly, but invasive adenomas will frequently require adjuvant therapy.
authors.affiliation: Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India.
authors.forename: Sauradeep
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
authors.forename: Simon
authors.initials: S
authors.lastname: Rajaratnam
authors.affiliation: Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India.
authors.forename: Geeta
authors.initials: G
authors.lastname: Chacko
authors.affiliation: Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College, Vellore, India. Electronic address: agchacko@cmcvellore.ac.in.
authors.forename: Ari George
authors.initials: AG
authors.lastname: Chacko
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000378:metabolism / Q000601:surgery; D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery; D000328:Adult; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000592:standards*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000592:standards*; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome
keywords: Acromegaly; Growth hormone; Pituitary adenoma; Transsphenoidal surgery