Abstract
The purpose of this study is to evaluate long-term results in acromegaly patients who received surgery as first-line treatment. Repeated surgery, radiation therapy and medical treatment were considered in patients showing no postoperative remission or who suffered a relapse. Thirty-five patients suffering from acromegaly were operated on between 1993 and 2009. The patients with persistent hypersecretion received a new surgery when postoperative imaging showed localized residual lesion. The other cases with persistent hypersecretion were treated medically using dopamine agonists, somatostatin analogs or pegvisomant according to the efficiency obtained. Radiotherapy was considered when medical treatment failed to normalize hormonal hypersecretion. The overall remission rate with surgery alone was 57 % (20/35):84 % (16/19) with non-invasive adenomas and 25 % (4/16) with invasive adenomas. Fifteen patients showing no remission after surgery received additional medical and/or radiation therapy resulting in hormonal control in ten of them. Recurrences after initial postoperative remission were observed in six patients who were controlled with subsequent therapy. Using a multimodal treatment approach, the disease was brought under control in 86 % (30/35) of acromegaly patients. Surgery alone produced satisfactory initial results in non-invasive adenomas, but additional treatments were required for most of the invasive lesions.
Similar content being viewed by others
References
Melmed S, Jackson I, Kleinberg D, Klibanski A (1998) Current treatment guidelines for acromegaly. J Clin Endocrinol Metab 83(8):2646–2652
Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, Veldhuis J, Wass J, Von Werder K, Melmed S (2000) Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 85(2):526–529
Hardy J (1991) Atlas of transsphenoidal microsurgery in pituitary tumors. Igaku-Shoin medical publishers, New York
Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33(4):610–617 Discussion 617–618
Kristof RA, Neuloh G, Redel L, Klingmüller D, Schramm J (2002) Reliability of the oral glucose tolerance test in the early postoperative assessment of acromegaly remission. J Neurosurg 97(6):1282–1286
D’Haens J, Van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B (2009) Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 72(4):336–340
Kabil MS, Eby JB, Shahinian HK (2005) Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg 48(6):348–354
Fahlbusch R, Honegger J, Buchfelder M (1997) Evidence supporting surgery as treatment of choice for acromegaly. J Endocrinol 155(Suppl 1):S53–S55
Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A, Acromegaly Consensus Group (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517
Beckers A (2008) Does preoperative somatostatin analog treatment improve surgical cure rates in acromegaly? A new look at an old question. J Clin Endocrinol Metab 93(8):2975–2977
Ludecke DK, Abe T (2006) Transsphenoidal microsurgery for newly diagnosed acromegaly: a personal view after more than 1,000 operations. Neuroendocrinology 83(3–4):230–239
Santoro A, Minniti G, Ruggeri A, Esposito V, Jaffrain-Rea ML, Delfini R (2007) Biochemical remission and recurrence rate of secreting pituitary adenomas after transsphenoidal adenomectomy: long-term endocrinologic follow-up results. Surg Neurol 68(5):513–518 Discussion 518
Gondim JA, Ferraz T, Mota I, Studart D, Almeida JP, Gomes E, Schops M (2009) Outcome of surgical intrasellar growth hormone tumor performed by a pituitary specialist surgeon in a developing country. Surg Neurol 72(1):15–19 Discussion 19
Biermasz NR, van Dulken H, Roelfsema F (2000) Ten-year follow-up results of transsphenoidal microsurgery in acromegaly. J Clin Endocrinol Metab 85(12):4596–4602
Biermasz NR, Dekker FW, Pereira AM, van Thiel SW, Schutte PJ, van Dulken H, Romijn JA, Roelfsema F (2004) Determinants of survival in treated acromegaly in a single center: predictive value of serial insulin-like growth factor I measurements. J Clin Endocrinol Metab 89(6):2789–2796
Beauregard C, Truong U, Hardy J, Serri O (2003) Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly. Clin Endocrinol (Oxf) 58(1):86–91
Nomikos P, Buchfelder M, Fahlbusch R (2005) The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol 152(3):379–387
Colao A, Cappabianca P, Caron P, De Menis E, Farrall AJ, Gadelha MR, Hmissi A, Rees A, Reincke M, Safari M, T’Sjoen G, Bouterfa H, Cuneo RC (2009) Octreotide LAR vs. surgery in newly diagnosed patients with acromegaly: a randomized, open-label, multicentre study. Clin Endocrinol (Oxf) 70(5):757–768
Bex M, Abs R, T’Sjoen G, Mockel J, Velkeniers B, Muermans K, Maiter D (2007) AcroBel: the Belgian acromegaly registry: a survey of the ‘real-life’ outcome in 418 acromegalic subjects. Eur J Endocrinol 157(4):399–409
Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, Casanueva FF, Trainer P, Ghigo E, Ho K, Melmed S, Acromegaly Consensus Group (2010) A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 95(7):3141–3148
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Van Rompaey, K., Unuane, D., Moens, M. et al. Long-term follow-up results of multimodal treatment with initial surgical approach for acromegaly in a single center. Acta Neurol Belg 113, 49–54 (2013). https://doi.org/10.1007/s13760-012-0128-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13760-012-0128-8