title: Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience.
abstract: BACKGROUND
  Acromegaly is a multisystemic disease that requires a multidisciplinary approach. The aim of this study was to determine early and late remissions of patients who underwent surgery at our center and to evaluate relations between pathologic and radiologic properties of adenoma and medical and radiosurgical treatments with remissions.
  
  
  METHODS
  The medical records of 103 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery in Cerrahpasa Medical Faculty, Istanbul University, between 2007 and 2014 were reviewed. Clinical, biochemical, radiologic, and pathologic properties were determined.
  
  
  RESULTS
  The total median follow-up time was 38 months [interquartile range: 24-53.5 months]. Thirty-two percent of the adenomas were microadenomas and 68% were macroadenomas The early remission rate was 51.5% and late remission was 75.2%. The sellar floor invasion was significantly lower in patients with early and late remissions (P = 0.01 and P = 0.009, respectively). The initial growth hormone (GH; P < 0.001), first-day GH (P = 0.03), 3-month GH (P = 0.001), insulin-like growth factor-1 (P = 0.004), and 6-month insulin-like growth factor-1 (P = 0.02) levels were significantly greater in patients with sellar floor invasion. The late remission rates (P = 0.004) were greter and reoperation needs (P = 0.05) were lower in patients with Ki-67 <3% than in patients with ≥3%. Seventy (68.6%) patients needed medical therapy during follow-up.
  
  
  CONCLUSIONS
  Late remission was achieved using a multidiciplinary approach in 75.2% of 103 patients with acromegaly, and young age, male sex, high Ki-67 and mitosis indices, and cavernous sinus and sellar-floor invasion had negative effects on clinical and biochemical control of the disease.
authors.affiliation: Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Haliloglu
authors.affiliation: Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Enis
authors.initials: E
authors.lastname: Kuruoglu
authors.affiliation: Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Hande Mefkure
authors.initials: HM
authors.lastname: Ozkaya
authors.affiliation: Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Fatma Ela
authors.initials: FE
authors.lastname: Keskin
authors.affiliation: Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Omur
authors.initials: O
authors.lastname: Gunaldi
authors.affiliation: Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Buge
authors.initials: B
authors.lastname: Oz
authors.affiliation: Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Nurperi
authors.initials: N
authors.lastname: Gazioglu
authors.affiliation: Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Pinar
authors.initials: P
authors.lastname: Kadioglu
authors.affiliation: Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address: nctan27@yahoo.com.
authors.forename: Necmettin
authors.initials: N
authors.lastname: Tanriover
mesh_terms: D000172:Acromegaly / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration*
keywords: Acromegaly; Early remission; Late remission; Proliferation indices