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Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study

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Abstract

Purpose

Growth hormone-secreting pituitary adenomas (GH-PAs) with a low Knosp grade are typically associated with a good postoperative biochemical remission (BR) rate. However, a proportion of patients do not achieve remission. In this study, we aimed to investigate predictive factors of postoperative remission for lower Knosp GH-PAs.

Methods

In this retrospective study, we enrolled 140 patients who were diagnosed with lower Knosp (0–2) GH-PAs and received trans-sphenoidal surgery between December 2016 and June 2021 from the largest pituitary tumor surgery center in southern China. The univariate, binary Logistic regression, and receiver operating characteristic curve (ROC) analyses were employed to determine independent predictors and cutoff values of remission. The postoperative outcome was defined as remission using the 2010 consensus criteria of acromegaly.

Results

One hundred and thirty six patients (97.1%) achieved gross total resection. The postoperative long-term BR was 68.6%. Empty sella, tumor maximum diameter and postoperative GH levels were independent factors predicting remission. ROC revealed that postoperative 24 h GH ≤ 1.3 ng/mL and  ≤ 1.23 ng/mL were valuable predictors for 3-month and long-term remission respectively, and that postoperative 3-month GH ≤ 1.6 ng/mL and tumor maximum diameter  ≤ 17 mm were predictors for delayed remission.

Conclusion

Early postoperative GH levels can be used as predictors of remission. However, BR was not associated with preoperative somatostatin analogs therapy or Knosp grade (0–2). For patients without residual tumor or recurrence and whose GH levels are slightly elevated within 1 year after surgery, adjuvant treatments may not be necessary.

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Data availability

Data are available upon request.

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Acknowledgements

We appreciate the assistance of colleagues from the Department of Neurosurgery and Imaging in gathering all the clinical data.

Funding

The study was funded by Clinical Research Project of The East Division (the First Affiliated Hospital, Sun Yat-sen University, 2019004), and Histology and Embryology, Construction Project of Postgraduate Demonstration Course of Guangdong Province, China (2020SFK004).

Author information

Author notes

  1. Shaolin Zhang, Jinping Chen, Yonghong Zhu, Haijun Wang and Zhigang Mao have equally contributed to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    S. Zhang, J. Chen, S. Yao, Z. Wang, B. Hu, D. Zhu, C. Duan, W. Chen, H. Wang & Z. Mao

  2. Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA

    F. Akter

  3. Department of Histology and Embryology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China

    Y. Zhu

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Contributions

Conceptualization: all authors; formal analysis and investigation: SZ and JC; funding acquisition: WC, YZ and HW; methodology: SZ, SY and DZ; project administration: ZM; resources: SZ, ZW and BH; supervision: HW and ZM; validation: SY and ZM; writing—original draft: SZ, SY and FA. All authors have read and approved submitted version.

Corresponding authors

Correspondence to Y. Zhu, H. Wang or Z. Mao.

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Conflict of interest

The authors have nothing relevant financial or non-financial interests to disclose. The authors have nothing to disclose.

Consent to participate

Informed consent was obtained from all subjects involved in the study.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University (No: 2020-091).

Research involving human participants and/or animals

The study involving human participants was reviewed and approved prior to commencing by The ethics committee of the First Affiliated Hospital of Sun Yat-sen University. No animal studies are presented in this study.

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Zhang, S., Chen, J., Yao, S. et al. Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study. J Endocrinol Invest 46, 465–476 (2023). https://doi.org/10.1007/s40618-022-01873-9

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