, Volume 60, Issue 3, pp 415–422 | Cite as

Predictors of surgical outcome and early criteria of remission in acromegaly

  • Ximene Antunes
  • Nina Ventura
  • Gustavo Bittencourt Camilo
  • Luiz Eduardo Wildemberg
  • Andre Guasti
  • Paulo José M. Pereira
  • Aline Helen Silva Camacho
  • Leila Chimelli
  • Paulo Niemeyer
  • Mônica R. Gadelha
  • Leandro Kasuki
Endocrine Surgery



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.


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.


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.


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.


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.

Key words

Acromegaly Surgery Predictors of surgical outcome Early criteria of remission 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12020_2018_1590_MOESM1_ESM.docx (19 kb)
Supplementary Table


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ximene Antunes
    • 1
  • Nina Ventura
    • 2
  • Gustavo Bittencourt Camilo
    • 3
  • Luiz Eduardo Wildemberg
    • 1
    • 4
  • Andre Guasti
    • 5
  • Paulo José M. Pereira
    • 5
  • Aline Helen Silva Camacho
    • 6
    • 7
  • Leila Chimelli
    • 6
  • Paulo Niemeyer
    • 5
  • Mônica R. Gadelha
    • 1
    • 4
  • Leandro Kasuki
    • 1
    • 4
    • 8
  1. 1.Neuroendocrinology Research Center / Endocrinology Division – Medical School and Hospital Universitário Clementino Fraga Filho – Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
  2. 2.Radiology Division - Instituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
  3. 3.Radiology Division - Instituição Hospital e Maternidade Terezinha de Jesus -Juiz de ForaMinas GeraisBrazil
  4. 4.Neuroendocrinology Division – Instituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
  5. 5.Neurosurgery Division – Instituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
  6. 6.Neuropathology and Molecular Genetics Laboratory – Instituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
  7. 7.Pathology Division – Instituto Nacional do CâncerRio de JaneiroBrazil
  8. 8.Endocrinology Division – Hospital Federal de BonsucessoRio de JaneiroBrazil

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