Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly

Abe, Takumi; Lüdecke, Dieter K.

doi:10.1046/j.1365-2265.1999.00591.x

Cited by 42 publications

(18 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Appropriate dilution was determined based on the preoperative GH levels. Intraoperative GH measurements were assayed at 0, 20, 40 and 60 min after initial tumor removal, as previously described [15][16][17]. A plasma GH level of 4.5 mg/l or less at 60 min after tumor removal was defined as a sufficient decline.…”

Section: Intraoperative Gh Measurementmentioning

confidence: 99%

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

2003

Self Cite

View full text Add to dashboard Cite

Abstract. Transsphenoidal surgery is the first therapeutic option in acromegaly, but the management of persistent or recurrent cases of the disease after surgery has been controversial. This study presented the results of secondary transnasal surgery for residual or recurring growth hormone (GH)-secreting macroadenoma with reference to intraoperative GH measurement. It focused on 22 patients who underwent secondary transsphenoidal surgery for 18 residual and 4 recurring GH-secreting pituitary macroadenomas from 1990 to 1999. To assess complete tumor removal, plasma GH concentration was measured intraoperatively. Before secondary surgery, plasma GH levels without medical treatment ranged from 2.0 to 239.0 mg/l (mean 31.5 +/-50.4). Magnetic resonance imaging demonstrated 16 transnasally resectable tumors and 6 nonresectable grossly invasive tumors. Intraoperative plasma GH concentrations declined sufficiently in 9 of 16 with transnasally resectable tumors, but in the remaining 7 cases the tumors were further explored and normalization of GH levels was ultimately obtained in 4 out of these cases. It was impossible to completely remove the tumors in all the 6 patients with transnasally nonresectable tumors. Thirteen of 22 patients achieved endocrinological remission by rigorous criteria. In transnasally resectable tumors, the endocrinological remission rate was 81.3% (13 of 16 patients) with no recurrence during the follow-up period of at least 4 years. Secondary transnasal surgery for residual or recurring GHsecreting pituitary macroadenomas is a safe and effective treatment, if done along with intraoperative GH measurement. Endocrinological remission can be obtained with high probability in patients who suffer from macroadenomas with suprasellar extension, with the exception of transnasally nonresectable grossly invasive tumors.

show abstract

Section: Intraoperative Gh Measurementmentioning

confidence: 99%

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

2003

Self Cite

View full text Add to dashboard Cite

show abstract

“…In fact, the differences in these factors have not been taken into account in other studies assessing the results of rapid GH measurement during surgery. 1,8,9) However, the present study clarified that neither preoperative octreotide treatment nor tumor cavernous sinus invasion influenced the utility of intraoperative rapid GH measurement to assess tumor removal.…”

Section: Discussionmentioning

confidence: 56%

“…However, the detection rate was low in the successful group (sensitivity 24.4%, specificity 83.8%) using a cut-off value of 50%. These criteria were previously applied only to cases with GH levels more than 40 mg/l before tumor removal, 1) but similarly the detection rate was 12.5% for the successful group and 83.3% for the unsuccessful group in the present series. In contrast, both sensitivity and specificity increased to 59.2% and 59.5%, respectively, using a cut-off value of 65%.…”

Section: Discussionmentioning

confidence: 82%

“…1) We also examined these indicators in our patients. Serum GH level was not a good predictor of tumor removal, but the reduction ratio (GH level at 20 minutes after the end of removal/GH level at the end of tumor resection) was significantly different between the successful and unsuccessful groups, indicating that this reduction ratio may be useful in distinguishing the two groups during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative rapid GH measurement has been developed and utilized in many institutions for this purpose. [1][2][3][4][5][7][8][9] However, no consensus has been reached on the criteria for complete tumor removal during surgery. We have used a specially-developed rapid GH assay to assess tumor removal during surgery since 1981.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Otani

Fukuhara

Ochi

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

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.

show abstract

Acromegaly: Surgical Management

Buchfelder¹,

Nomikos²

Diagnosis and Management of Pituitary Disorders

View full text Add to dashboard Cite

Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly

Abstract: Secondary surgery based on intraoperative GH measurement improves the outcome of tumour resection in patients with non-invasive GH secreting macroadenomas.

Cited by 42 publications

References 36 publications

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

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

Acromegaly: Surgical Management

Contact Info

Product

Resources

About