Rapid Growth Hormone Measurement During Transsphenoidal Surgery: Analysis of 252 Acromegalic Patients

Abstract

The usefulness of rapid growth hormone (GH) measurement was retrospectively evaluated as an indicator of total tumor removal during surgery and compared with several reported criteria in 252 acromegalic patients who underwent transsphenoidal surgery at Toranomon Hospital between 2006 and 2008. GH levels were measured in blood samples obtained before surgery, at the start of tumor removal, and every 20 minutes thereafter until 20 minutes after total tumor removal as judged by the operator. Intraoperative GH dynamics were compared between 201 patients fulfilling the Cortina consensus criteria (successful group) and 37 patients who did not (unsuccessful group). Among several criteria indicating total tumor removal, only the ratio of serum GH level 20 minutes after the end of tumor removal to GH level at the end of tumor excision was significantly different between the groups; a reduction ratio of 65% was the most appropriate cut-off value based on sensitivity (59.2%) and specificity (59.5%). The ratio of GH level 20 minutes after the end of tumor removal/GH level at the end of tumor excision was the most reliable index to judge tumor removal during surgery, but this index is neither necessary nor sufficient and should be used as one of the indicators to judge complete tumor removal during surgery.

The quality of life in acromegalic patients with biochemical remission by surgery alone is superior to that in those with pharmaceutical therapy without radiotherapy, using the newly developed Japanese version of the AcroQoL

“…Another plausible and interesting possibility is that the improvement effect on appearance differs between the 2 therapeutic methods. The surgery normalizes serum GH and IGF-I levels more rapidly [34] than pharmaceutical therapy [35,36]. This may result in relatively rapid changes in appearance, and the patients perceive the improvement more clearly than those who undergo pharmaceutical therapy.…”

Cut-off Value for Stenosis Ratio and Zung Depression Scale in Successful Prediction of Posterior Spinal Fusion surgery

“…18 Otani et al measured a cut-off point for growth hormone levels in blood samples as an indicator and predictor of postoperation in transsphenoidal surgery. 19 Takenaka et al calculated cut-off values for C-methionine, C-choline and F-fluorodeoxyglucose positron emission tomography to diagnose glioma recurrence. 20 Based on the aforementioned, determination of a range or value for some important clinical factors can give an insight into the surgeon.…”

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“…However, they commented that the results obtained were not used in their study for perioperative decisions. Otani et al [45] measured GH in blood samples obtained before surgery, at the start of tumour removal and every 20 min thereafter until 20 min after tumour resection. Among several criteria indicating total tumour removal, only the level of serum GH 20 min after the end of tumour excision was significantly different between those patients who remitted according to the Cortina Consensus Criteria [8] and those in which the disease persisted after surgery.…”