Evaluation of transsphenoidal adenomectomy outcomes in acromegaly using different remission criteria

Tsiberkin, Alexandr; Tsoy, Uliana; Cherebillo, V. Yu.; Polezhaev, A V; Gussarova, N V; Grineva, Elena

doi:10.17116/neiro20198301198

Cited by 4 publications

(1 citation statement)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…По данным большинства исследователей, ремиссии акромегалии после хирургического лечения достигают 80-90% среди пациентов с микроаденомами гипофиза и 40-60% при наличии макроаденом [2, 3,6]. Вариабельность частоты ремиссии между исследованиями может быть объяснена различиями в используемых критериях биохимической ремиссии акромегалии и выборках пациентов [3,14,15]. Согласно результатам крупного метаанализа средняя частота ремиссии акромегалии после хирургического лечения составляла 54,8%; показатель достиг 77,9% у пациентов с микроаденомами и 52,7% при макроаденомах гипофиза [3].…”

Section: îáñóAeäåíèåunclassified

Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

Tsiberkin

Tsoy

Cherebillo

et al. 2020

Terapevticheskii arkhiv

Self Cite

View full text Add to dashboard Cite

Aim.To investigate the value of 24 hours post-surgery measurement of growth hormone (GH) level for prognosis of surgical outcomes in acromegaly. Materials and methods.A prospective cohort study included 45 patients with newly diagnosed acromegaly. The degree of parasellar extension was measured on the preoperative sellar magnetic resonance imaging according to the Knosps classification. All patients underwent a transsphenoid adenomectomy performed by one neurosurgeon. Basal GH level was measured at 24 hours after surgery. The efficacy of transsphenoidal adenomectomy evaluated at 12 months after surgery. Results.Acromegaly remission was achieved in 19 (42%) of 45 patients at 12 months after surgery. Pituitary microadenomas and the absence of paracellular invasion, corresponding to Knosp Grade 02, had low prognostic value for long-term remission due to low sensitivity (31.6%) and low specificity (38.5%), respectively. The highest prognostic value for acromegaly remission was showed for 24 hours post-surgery GH level with cut-off 1.30 ng/ml with sensitivity of 96.2% (95% confidence interval 81.199.8%) and specificity of 84.2% (95% confidence interval 62.494.4%). Conclusion.The study demonstrated the possibility of using GH level at 24 after surgery as a predictor for acromegaly remission. GH level 1.30 ng/ml at 24 hours after surgery showed better predictive value for long-term remission compared with the presence of microadenomas and Knosp Grade 02. The absence of decrease of GH level on the first day after surgery may serve as a reason for more close monitoring of patients in the postoperative period. Further studies in a larger number of observers are required to confirm our findings.

show abstract

Section: îáñóAeäåíèåunclassified

Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

Tsiberkin

Tsoy

Cherebillo

et al. 2020

Terapevticheskii arkhiv

Self Cite

View full text Add to dashboard Cite

show abstract

Intraoperative characteristics of somatotropinomas

Senko

Крылов

Dashyan

et al. 2023

Nejrohirurgiâ (Mosk.)

Self Cite

View full text Add to dashboard Cite

Background. Acromegaly is a rare disease associated with insulin‑like growth factor 1 hyperproduction due to the presence of pituitary adenoma in the patient. The first‑line treatment of such patients is surgical removal of the formation in order to normalize hormonal status. The main predictors of the ineffectiveness of surgical treatment and relapse of the disease are large tumor size, tumor invasion into the cavernous sinus, and high preoperative levels of growth hormone, as well as Ki‑6 % expression. The search for additional risk factors for disease recurrence, which according to various sources is approximately 30 % after primary surgical treatment, is an urgent task for researchers. In our work, we studied the intraoperative characteristics of the tumor, size of pituitary adenomas according to preoperative magnetic resonance imaging of the brain, degree of invasion of the tumor into the cavernous sinus according to the Knosp classification and compared them with disease outcomes after a year of follow‑up after surgical treatment.Aim. To identify new markers of aggressive progression of pituitary tumors.Materials and methods. A retrospective analysis of medical documentation, protocols of operations of 90 patients aged between 19 and 73 years with the diagnosis of growth hormone‑secreting pituitary adenoma was performed. The dia gnosis was confirmed based on clinical picture, laboratory and instrumental examination methods. All patients underwent endoscopic transsphenoidal removal of pituitary adenoma by one surgeon in one medical institution between 2017 and 2019.Results. Intraoperative characteristics of the tumor, such as the color of the solid component, density, degree of vascularization were compared with the results of laboratory and instrumental data, as well as the results of surgical treatment after a year of follow‑up.Conclusion. Such intraoperative characteristics of growth hormone‑secreting pituitary adenomas as the purplish‑gray color of the solid component, high vascularization, as well as dense‑elastic consistency of the tumor, can be considered high risk factors for continued tumor growth in the first 6 months after surgical treatment or relapse of the disease during a year of follow‑up.

show abstract

Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies

Ilovayskaya,

Galstyan

2023

Almanac of Clinical Medicine

View full text Add to dashboard Cite

The prevalence of diabetes mellitus in acromegaly is significantly higher than that in the general population. Carbohydrate metabolism abnormalities often precede other phenotypic manifestations of acromegaly. The review presents data on the prevalence of carbohydrate metabolism disorders in acromegaly and describes their pathophysiological characteristics and approaches to treatment. Growth hormone (GH) excess is recognized as a key factor of glucose homeostasis abnormalities due to decreased insulin sensitivity (resulting from active lipolysis) and direct stimulation of insulin secretion. Insulin-like growth factor 1 (IGF1) improves insulin sensitivity; however, the GH diabetogenic effects prevail over the insulin-sensitizing impact of IGF1. Surgical and radiation treatment for somatotropinoma may indirectly improve carbohydrate metabolism, because they decrease the GH levels. Treatment with first generation somatostatin analogues can both improve glycemic control due to decreased GH levels and worsen it due to deterioration of postprandial insulin release, especially in patients with already manifest carbohydrate metabolism disorders. The GH receptor antagonist pegvisomant blocks the effects of excess GH on the target tissues without suppressing insulin secretion, which results in better glucose control; treatment with this agent can be preferred in patients with acromegaly and diabetes mellitus. Management of carbohydrate metabolism disorders in acromegaly is done in accordance with general treatment principles for type 2 diabetes mellitus.

show abstract

Evaluation of transsphenoidal adenomectomy outcomes in acromegaly using different remission criteria

Cited by 4 publications

References 27 publications

Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

Intraoperative characteristics of somatotropinomas

Diabetes mellitus in acromegaly: prevalence, pathophysiological particulars and treatment strategies

Contact Info

Product

Resources

About