Abstract
Objectives To analyze surgical outcomes and predictive factors of disease remission in acromegaly
patients who underwent microscopic transsphenoidal surgery (TSS) for a growth hormone
(GH)-secreting adenoma.
Design A 6-year retrospective review of 86 consecutive acromegaly surgeries.
Setting Procedures performed at a single institution by a single surgeon.
Participants Seventy acromegaly patients.
Main Outcome Measures Demographic information, preoperative laboratory values, tumor imaging data, and
morphological and immunohistochemical data were collected. Predictive values using
the latest and most stringent biochemical remission criteria were determined using
univariate and multivariate statistical analyses.
Results Remission rate for 59 (18 males) acromegaly patients meeting the study inclusion
criteria was 52.5%. Remission rates for micro- and macroadenomas were 81.8% and 45.8%,
respectively. Patients of older age, with a smaller tumor, lower Knosp grade, lower
preoperative GH, and insulinlike growth factor 1 levels were more likely to achieve
remission. Remission rate decreased significantly with repeat surgeries. Those patients
with adenomas that stained positive for somatostatin receptor subtype 2A were less
likely to experience tumor recurrence and more likely to respond to medical treatment
with persistent or elevated GH hypersecretion.
Conclusions Microscopic TSS continues to be a viable means for treating acromegaly patients.
Patients should be followed long term.
Keywords
acromegaly - remission - transsphenoidal surgery
