The Birmingham pituitary database: auditing the outcome of the treatment of acromegaly

Jenkins, David; O'Brien, I.A.D.; Johnson, A. G.; Shakespear, R. A.; Sheppard, M. C.; Stewart, Paul M.

doi:10.1111/j.1365-2265.1995.tb02913.x

Cited by 86 publications

(62 citation statements)

References 13 publications

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“…Because the criteria for "cure" in acromegaly have evolved over the last two decades, recent studies have employed more stringent GH values such as < 2.5 ng/ml [15,16], 2 ng/ml [8] or 0.5 ng/ ml [17]. In addition, some authors have used normalization of the postoperative IGF-1 / somatomedin-C level [7,9,17] or normalization of the GH response to TRH, GnRH or oGTT as indicating a satisfactory outcome [8,15].…”

Section: Discussionmentioning

confidence: 99%

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

et al. 1997

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Abstract.A series of 44 patients with acromegaly underwent transsphenoidal surgery between 1987 and 1996. The early postoperative mean basal GH level < 5 ng/ml or < 3 ng/ml was achieved in 43 (97.7%) or 38 (86.4%) out of 44 patients, respectively. Preoperative abnormal GH secretory response to TRH, GnRH and oral glucose administration was restored to normal both after surgery and at the time of the final follow-up in all patients whose early postoperative mean basal GH levels were reduced to < 3 ng/ ml, whereas they remained abnormal in those with mean basal GH levels of > 3 ng/ml. In contrast, insulin-like growth factor 1 (IGF-1) levels, when measured by the extraction method, tended to be reduced gradually to normal between 6 months and 2 years after surgery in some patients with a successful operation.Therefore, 34 (87.1%) out of 39 patients who have been followed up longer than 6 months met the following stringent criteria at the time of the final follow-up: mean basal GH level < 3 ng/ml, a normal IGF-1 level, and normal GH response to TRH, GnRH and oral glucose administration. In this series, the most unfavorable preoperative factor influencing operative outcome is tumor invasion of the cavernous sinus. Our results clearly indicate that selective adenomectomy by transsphenoidal surgery is the therapy of first choice in any patient with acromegaly and that the complete biochemical cure of acromegaly can be achieved in 87% of patients by surgery alone with an acceptable low surgical morbidity.

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Section: Discussionmentioning

confidence: 99%

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

et al. 1997

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“…Even in published series, cure rates vary tremendously and an inverse correlation has been found between the number of neurosurgeons operating in one centre and the cure rate (23,26), varying between 37% and 91% for microadenomas (20,27). More patients underwent radiotherapy before 1991 once somatostatin analogues became available.…”

Section: Cause Of Deathmentioning

confidence: 99%

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)

Mestrón

Webb

Astorga

et al. 2004

European Journal of Endocrinology

351

232

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Objective: To undertake a multicentre epidemiological study reflecting acromegaly in Spain. Design: Voluntary reporting of data on patients with acromegaly to an online database, by the managing physician. Methods: Data on demographics, diagnosis, estimated date of initial symptoms and diagnosis, pituitary imaging, visual fields, GH and IGF-I concentrations (requested locally), medical, radiotherapy and neurosurgical treatments, morbidity and mortality were collected. Results: Data were included for 1219 patients (60.8% women) with a mean age at diagnosis of 45 years (S.D. 14 years). Reporting was maximal in 1997 (2.1 cases per million inhabitants (c.p.m.) per year); prevalence was globally 36 c.p.m., but varied between 15.7 and 75.8 c.p.m. in different regions. Of 1196 pituitary tumours, most were macroadenomas (73%); 81% of these patients underwent surgery, 45% received radiotherapy and 65% were given medical treatment (somatostatin analogues in 68.3% and dopamine agonists in 31.4%). Cures (GH values (basal or after an oral glucose tolerance test) , 2 ng/ml, normal IGF-I, or both) were observed in 40.3% after surgery and 28.2% after radiotherapy. Hypertension (39.1%), diabetes mellitus (37.6%), hypopituitarism (25.7%), goitre (22.4%), carpal tunnel syndrome (18.7%) and sleep apnoea (13.2%) were reported as most frequent morbidities; 6.8% of the patients had cancer (breast in 3.1% of the women and colon in 1.2% of the cohort). Fifty-six patients died at a mean age of 60 years (S.D. 14 years), most commonly of a cardiovascular cause (39.4%); mortality was greater in patients given radiotherapy (hazard ratio 2.29; 95% confidence interval 1.03 to 5.08; P ¼ 0.026), and in those in whom GH and IGF-I concentrations were never normal (P , 0.001). Conclusions: This acromegaly registry offers a realistic overview of the epidemiological characteristics, treatment outcome and morbidity of acromegaly in Spain. As active disease and treatment with radiotherapy are associated with an increase in mortality, efforts to control the disease early are desirable.

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“…Normalização do GH foi relatada em 40 a 91% dos microadenomas e 23 a 53% dos macros (66,82,87,89,90). Na Inglaterra, níveis de GH <2,5 ng/mL são observados com uma freqüência significativamente maior em serviços onde um único neurocirurgião realiza a TSA (90).…”

Section: Cirurgiaunclassified

Tratamento medicamentoso dos tumores hipofisários. Parte I: prolactinomas e adenomas secretores de GH

Vilar

Naves

Freitas

et al. 2000

Arq Bras Endocrinol Metab

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RESUMOO recente desenvolvimento de novas drogas, particularmente os aná-logos da somatotastina (SRIFa), representou um grande progresso na terapia dos tumores hipofisários. Os SRIFa mostram-se bastante eficazes na normalização dos níveis de GH e IGF-1 em acromegálicos e podem ser uma alternativa para a cirurgia transesfenoidal, mas seu uso como terapia primária da acromegalia fica limitado pelo pequeno efeito dessas drogas na redução das dimensões do tumor. Os resultados preliminares com os antagonistas do receptor de GH, como o pegvisomant, são bastante animadores. Tais drogas permitem a normalização do IGF-1 e melhora clínica em mais de 80% dos casos; entretanto, não causam redução tumoral. Agonistas dopaminérgicos (DA) representam a terapia de escolha para microprolactinomas sintomáticos e macroprolactinomas, permitindo normalização dos níveis da prolactina e redução do volume do adenoma na maioria dos pacientes. Podem também ser eventualmente eficazes em acromegálicos, sobretudo naqueles com adenomas co-secretores de prolactina e níveis não muito elevados de GH e IGF-1. Devido a sua maior eficácia e melhor tolerabilidade, a cabergolina representa o DA de escolha para o manuseio dos prolactinomas e da acromegalia. ABSTRACTThe recent development of new drugs, particularly the somatostatin analogues (SRIFa), represents a great advance in the therapy of pituitary tumours. SRIFas are very effective in normalizing GH and IGF-1 levels in acromegaly and may be an effective alternative to transsphenoidal surgery. However, their usefulness as primary therapy for acromegaly is limited due to the small effect on tumour size. According to early data from clinical trials, pegvisomant, a GH receptor antagonist, seems to be a promising therapeutic tool in the management of acromegalic patients. This drug induces significant clinical improvement and normalization of IGF-1 levels in nearly all patients. However, it does not induce tumor shrinkage. Dopamine agonists (DA) are the preferred therapy for both symptomatic microprolactinomas and macroprolactinomas; their use result in normalization of prolactin levels and tumor shrinkage in most treated patients. They also may be useful in acromegaly, mainly in patients whose adenoma co-secrete prolactin and those with mild elevation of GH and IGF-1 levels. Due to its greater effectiveness and better tolerability, cabergoline represents the DA of choice for the management of prolactinomas and acromegaly.

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The Birmingham pituitary database: auditing the outcome of the treatment of acromegaly

Abstract: Biochemical cure of acromegaly was more strongly associated with pretreatment GH than with tumour size. Random/basal GH measurements are useful and convenient for the audit of treatment outcome in acromegaly. Ways of improving the biochemical outcome of acromegaly should be sought.

Cited by 86 publications

References 13 publications

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

The Results of Transsphenoidal Surgery for 44 Consecutive Acromegalic Patients.

Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA)

Tratamento medicamentoso dos tumores hipofisários. Parte I: prolactinomas e adenomas secretores de GH

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