Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients

Abstract

Of 214 patients with acromegaly who underwent transsphenoidal microsurgical resection of a pituitary adenoma, 54% had growth hormone (GH) levels below 5 ng/ml and 74% had levels less than 10 ng/ml immediately after surgery. Among the 174 patients who could be contacted for long-term follow-up review (average duration 76 months), most recent GH determinations were available for 165. Of these 165 patients, 131 (79.4%) have a GH level less than 5 ng/ml and 153 (92.7%) have a level below 10 ng/ml; these represent 75.3% and 87.9%, respectively, of the total 174 patients reviewed. Fifty-two patients received postoperative radiation therapy. Nine patients underwent reoperation. There were five cases of tumor recurrence following an apparent surgical cure (4.3%), nine new instances of anterior pituitary hypofunction (5%), and five failures of multimodality therapy (2.3%). There were no perioperative deaths, five cases of cerebrospinal fluid leak requiring surgical repair (2.2%), and four cases of postoperative meningitis (1.8%). Permanent diabetes insipidus did not occur. Two of 52 patients who were irradiated postoperatively had severe complications; 23 (54.8%) of 42 patients who were available for follow-up evaluation had developed panhypopituitarism; and eight (19%) of 42 had normal pituitary function an average of 44 months postirradiation.

The surgical treatment of pituitary adenomas in the eighth decade

“…Undoubtedly, it is usually wiser to refer these patients for medical and/or radiation therapy whenever possible, than to recommend surgery. Our experience, in agreement with other authors [3][4][5]18,19,21], suggests that the surgical treatment of pituitary adenomas diagnosed in the eighth decade of life is certainly feasible, as supported by the results of the present series, with no mortality.…”

“…P ituitary adenoma is not considered a disease of advanced age; its incidence is rated around 3-4% [14,18,19,21,25]. Yet the age-related functional endocrine and visual impairment of elderly people may occasionally delay or even hinder the correct diagnosis of pituitary adenoma [5].…”

Endoscopic endonasal transsphenoidal treatment for acromegaly: 2010 consensus criteria for remission and predictors of outcomes

“…The main aim in the treatment of acromegaly is the total resection of the tumor if possible, prevention of its recurrence and to restore the normal GH/ IGF-1 levels with the long-term aim of avoiding increased morbidity and mortality associated with uncontrolled serum GH and IGF-1 levels (22,26,28,34).…”

Overexpression of the growth hormone-releasing hormone gene in acromegaly-associated pituitary tumors: An event associated with neoplastic progression andaggressive behavior

“…Whereas some somatotroph adenomas are amenable to curative resection, others will progress relentlessly, often despite maximal surgical, pharmacological, and radiotherapeutic intervention.1 It is recognized that some 80% of GH-secreting adenomas will have progressed to a macroadenoma stage when detected, and one-half of these will be grossly invasive of surrounding neurovascular or bony structures.2 4 Curative resections can be achieved by experienced surgeons in only 55 to 65% of all somatotroph adenomas. [5][6][7] In the remainder, it is usually tumor invasiveness that precludes complete excision, and for these tumors, symptomatic regrowth and persistent hormone hypersecretion are virtually guaranteed.8`10 The tendencies of some somatotroph adenomas toward aggressive, invasive, or recurrent growth, although neither reflected in nor predicted by the tumor's histological or ultrastructural morphology, is presumably the result of specific subcellular events that promote neoplastic progression among aggressive variants. To date, however, prognostically informative determinants of neoplastic progression remain poorly characterized in this tumor system.…”