Management Options for Persistent Postoperative Acromegaly

Mathioudakis, Nestoras; Salvatori, Roberto

doi:10.1016/j.nec.2012.06.005

Cited by 11 publications

(9 citation statements)

References 98 publications

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“…As for primary surgery, the overall remission rate after a re-operation is highly variable between series (ranging from 8% to 59%). 115,116 This is probably due to the lack of standardized recommendations for a second intervention and no clear stratification between surgically resectable and unresectable tumors. As an example, Abe and colleagues, based on Lüdecke's classification system and intraoperative GH measurement, reported a biochemical remission rate after a second surgery of 88.9% in resectable adenomas and 57.1% including not resectable tumors.…”

Section: Non-medical Secondary Treatment Second Surgery For Uncontrolmentioning

confidence: 99%

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

Corica¹,

Ceraudo²,

Campana³

et al. 2020

TCRM

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Acromegaly is a rare and severe disease caused by an increased and autonomous secretion of growth hormone (GH), thus resulting in high circulating levels of insulin-like growth factor 1 (IGF-1). Comorbidities and mortality rate are closely related to the disease duration. However, in most cases achieving biochemical control means reducing or even normalizing mortality and restoring normal life expectancy. Current treatment for acromegaly includes neurosurgery, radiotherapy and medical therapy. Transsphenoidal surgery often represents the recommended first-line treatment. First-generation somatostatin receptor ligands (SRLs) are the drug of choice in patients with persistent disease after surgery and are suggested as first-line treatment for those ineligible for surgery. However, only about half of patients treated with octreotide (or lanreotide) achieve biochemical control. Other available drugs approved for clinical use are the second-generation SRL pasireotide, the dopamine agonist cabergoline, and the GH-receptor antagonist pegvisomant. In the present paper, we revised the current literature about the management of acromegaly, aiming to highlight the most relevant and recent therapeutic strategies proposed for patients resistant to first-line medical therapy. Furthermore, we discussed the potential molecular mechanisms involved in the variable response to first-generation SRLs. Due to the availability of different medical therapies, the choice for the most appropriate drug can be currently based also on the peculiar clinical characteristics of each patient.

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Section: Non-medical Secondary Treatment Second Surgery For Uncontrolmentioning

confidence: 99%

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

Corica¹,

Ceraudo²,

Campana³

et al. 2020

TCRM

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“…31 Treatment options for those cases include medical therapy, radiation therapy, and reoperation. 32,42,44 Somatostatin receptor ligands (octreotide, lanreotide), dopamine agonists (cabergoline), and pegvisomant, a human GH receptor antagonist, are important tools in the management of acromegaly, but the costs of treatment, lifelong therapy, and the occurrence, in some cases, of major side effects represent important limitations of medical therapy. 3,4,24 Stereotactic radiotherapy plays a role in the treatment of residual tumors after resective surgery, particularly if medical therapy is not available or successful.…”

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confidence: 99%

“…24,32,43,65 Reoperation for persistent acromegaly is recommended when residual intrasellar tumor is observed and/or adjuvant therapy is not effective or cannot be performed due to a patient's economic limitations. 32,42 Hormonal control rates after repeat surgery have been historically inferior to those achieved after initial surgery. 1,42,64 However, we hypothesize that with the implementation of EEA, current results of reoperation for GH-secreting adenomas may be better than previously reported and may be similar to results of first-time surgery.…”

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confidence: 99%

“…32,42 Hormonal control rates after repeat surgery have been historically inferior to those achieved after initial surgery. 1,42,64 However, we hypothesize that with the implementation of EEA, current results of reoperation for GH-secreting adenomas may be better than previously reported and may be similar to results of first-time surgery. In the current study we evaluated the results of EEA performed by a dedicated endoscopic skull base team for reoperation in patients with persistent acromegaly.…”

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confidence: 99%

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Reoperation for growth hormone–secreting pituitary adenomas: report on an endonasal endoscopic series with a systematic review and meta-analysis of the literature

Almeida¹,

Ruiz-Treviño²,

Liang³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Surgery is generally the first-line therapy for acromegaly. For patients with residual or recurrent tumors, several treatment options exist, including repeat surgery, medical therapy, and radiation. Reoperation for recurrent acromegaly has been associated with poor results, with hormonal control usually achieved in fewer than 50% of cases. Extended endonasal endoscopic approaches (EEAs) may potentially improve the results of reoperation for acromegaly by providing increased visibility and maneuverability in parasellar areas. METHODS A database of all patients treated in the authors' center between July 2004 and February 2016 was reviewed. Cases involving patients with acromegaly secondary to growth hormone (GH)-secreting adenomas who underwent EEA were selected for chart review and divided into 2 groups: first-time surgery and reoperation. Disease control was defined by 2010 guidelines. Clinical and radiological characteristics and outcome data were extracted. A systematic review was done through a MEDLINE database search (2000-2016) to identify studies on the surgical treatment of acromegaly. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the included studies were reviewed for surgical approach, tumor size, cavernous sinus invasion, disease control, and complications. Cases were divided into reoperation or first-time surgery for comparative analysis. RESULTS A total of 44 patients from the authors' institution were included in this study. Of these patients, 2 underwent both first-time surgery and reoperation during the study period and were therefore included in both groups. Thus data from 46 surgical cases were analyzed (35 first-time operations and 11 reoperations). The mean length of follow-up was 70 months (range 6-150 months). The mean size of the reoperated tumors was 14.8 ± 10.0 mm (5 micro- and 6 macroadenomas). The patients' mean age at the time of surgery was younger in the reoperation group than in the first-time surgery group (34.3 ± 12.8 years vs 49.1 ± 15.7 years, p = 0.007) and the mean preoperative GH level was also lower (7.7 ± 13.1 μg/L vs 25.6 ± 36.8 μg/L, p = 0.04). There was no statistically significant difference in disease control rates between the reoperation (7 [63.6%] of 11) and first-time surgery (25 [71.4%] of 33) groups (p = 0.71). Univariate analysis showed that older age, smaller tumor size, lower preoperative GH level, lower preoperative IGF-I level, and absence of cavernous sinus invasion were associated with higher chances of disease control in the first-time surgery group, whereas only absence of cavernous sinus invasion was associated with disease control in the reoperation group (p = 0.01). There was 1 case (9%) of transient diabetes insipidus and hypogonadism and 1 (9%) postoperative nasal infection after reoperation. The systematic review retrieved 29 papers with 161 reoperation and 2189 first-time surgery cases. Overall disease control for reoperation was 46.8% (95% CI 20%-74%) versus 56.4% (95% CI 49%-63%) for first...

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“…Numerous smaller series in the literature largely support these values, with surgical remission rates ranging to 60% ( 14 – 20 ). Reported recurrence rates in the literature to date vary widely due to the different criteria for biochemical remission and varying years of follow-up; recurrence rates ranging from 0.4 to 19% ( 7 , 13 , 17 , 21 – 23 ) are reported, with one 2012 meta-analysis citing a mean 6% recurrence rate within 10 years ( 20 ).…”

Section: Growth Hormone-secreting Adenomasmentioning

confidence: 99%

Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly and Cushing Disease Paradigms

2016

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The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment.

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Management Options for Persistent Postoperative Acromegaly

Cited by 11 publications

References 98 publications

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

<p>Octreotide-Resistant Acromegaly: Challenges and Solutions</p>

Reoperation for growth hormone–secreting pituitary adenomas: report on an endonasal endoscopic series with a systematic review and meta-analysis of the literature

Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly and Cushing Disease Paradigms

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