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Predictors of surgical outcome and early criteria of remission in acromegaly

  • Endocrine Surgery
  • Published:
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Abstract

Background

Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery.

Purpose

To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier.

Methods

Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH <1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission.

Results

Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (p = 0.017). A GH <1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity.

Conclusion

Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.

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Authors and Affiliations

  1. Neuroendocrinology Research Center / Endocrinology Division – Medical School and Hospital Universitário Clementino Fraga Filho – Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Ximene Antunes, Luiz Eduardo Wildemberg, Mônica R. Gadelha & Leandro Kasuki

  2. Radiology Division - Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Nina Ventura

  3. Radiology Division - Instituição Hospital e Maternidade Terezinha de Jesus -Juiz de Fora, Minas Gerais, Brazil

    Gustavo Bittencourt Camilo

  4. Neuroendocrinology Division – Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Luiz Eduardo Wildemberg, Mônica R. Gadelha & Leandro Kasuki

  5. Neurosurgery Division – Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Andre Guasti, Paulo José M. Pereira & Paulo Niemeyer

  6. Neuropathology and Molecular Genetics Laboratory – Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Aline Helen Silva Camacho & Leila Chimelli

  7. Pathology Division – Instituto Nacional do Câncer, Rio de Janeiro, Brazil

    Aline Helen Silva Camacho

  8. Endocrinology Division – Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil

    Leandro Kasuki

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  1. Ximene Antunes
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  2. Nina Ventura
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  3. Gustavo Bittencourt Camilo
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Correspondence to Leandro Kasuki.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Antunes, X., Ventura, N., Camilo, G.B. et al. Predictors of surgical outcome and early criteria of remission in acromegaly. Endocrine 60, 415–422 (2018). https://doi.org/10.1007/s12020-018-1590-8

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