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The common consensus criteria have high predictive values for long-term postoperative acromegaly remission

  • Clinical Article
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Abstract

Objective

The aim of this work was to retrospectively study the long-term reliability of the common consensus endocrinological criteria for the assessment of postoperative remission of acromegaly.

Patients and methods

In 96 consecutive patients, surgical remission of acromegaly following transsphenoidal surgery was considered to be present when, without adjuvant treatment, 3 months postoperatively there was no clinical evidence of persisting disease, and, according to the common consensus criteria for acromegaly remission, GH was suppressed to <1 μg/l during the oral glucose tolerance test (OGTT) and insulin like growth factor-1 (IGF-1) was within normal limits. The results of the second postoperative week, 3 months postoperative, and the most recent follow-up OGTT and IGF-1 measurements were used to calculate the positive and negative predictive values of the following endocrinological criteria of acromegaly remission: the common consensus criteria for acromegaly remission, GH suppression to <1 μg/l during OGTT and IGF-1 within normal limits. Sensitive IRMA (≤0.3 μg/l) and RIA (≤32 μg/l) assays for GH and IGF-1 were used.

Results

The surgical remission rate of acromegaly was 72.9%. At a median follow-up of 5.06 years, the recurrence rate of acromegaly was 2.08%. Overall, the common consensus criteria for acromegaly remission were the most reliable tests, with the following positive and negative predictive values at 2 weeks postoperatively, 3 months postoperatively and at the most recent follow-up: 68%, 100% and 100%, and 98%, 100% and 100%, respectively. The negative likelihood ratio confirmed that the test qualities of the common consensus criteria for acromegaly remission were superior to the other tests.

Conclusions

The common consensus criteria were the most reliable tests for the diagnosis of postoperative acromegaly remission. The positive and negative predictive values of the common consensus criteria for acromegaly remission increased from the second postoperative week to 3 months postoperatively, thereafter reliably indicating the long-term results of transsphenoidal surgery.

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References

  1. Arafat AM, Mohlig M, Weickert MO, Perschel FH, Purschwitz J, Spranger J, Strasburger CJ, Schofl C, Pfeiffer AF (2008) Growth hormone response during oral glucose tolerance test: the impact of assay method on the estimation of reference values in patients with acromegaly and in healthy controls, and the role of gender, age, and body mass index. J Clin Endocrinol Metab 93(4):1254–1262

    Article  CAS  PubMed  Google Scholar 

  2. Buchfelder M, Brockmeier S, Fahlbusch R, Honegger J, Pichl J, Manzl M (1991) Recurrence following transsphenoidal surgery for acromegaly. Horm Res 35(3–4):113–118

    Article  CAS  PubMed  Google Scholar 

  3. Carmichael JD, Bonert VS, Mirocha JM, Melmed S (2009) The utility of oral glucose tolerance testing for diagnosis and assessment of treatment outcomes in 166 patients with acromegaly. J Clin Endocrinol Metab 94(2):523–527

    Article  CAS  PubMed  Google Scholar 

  4. De P, Rees DA, Davies N, John R, Neal J, Mills RG, Vafidis J, Davies JS, Scanlon MF (2003) Transsphenoidal surgery for acromegaly in wales: Results based on stringent criteria of remission. J Clin Endocrinol Metab 88(8):3567–3572

    Article  CAS  PubMed  Google Scholar 

  5. Dobrashian RD, O'Halloran DJ, Hunt A, Beardwell CG, Shalet SM (1993) Relationships between insulin-like growth factor-1 levels and growth hormone concentrations during diurnal profiles and following oral glucose in acromegaly. Clin Endocrinol (Oxf) 38(6):589–593

    Article  CAS  Google Scholar 

  6. Feelders RA, Bidlingmaier M, Strasburger CJ, Janssen JA, Uitterlinden P, Hofland LJ, Lamberts SW, van der Lely AJ, de Herder WW (2005) Postoperative evaluation of patients with acromegaly: clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor i, acid-labile subunit, and growth hormone-binding protein levels. J Clin Endocrinol Metab 90(12):6480–6489

    Article  CAS  PubMed  Google Scholar 

  7. Freda PU, Nuruzzaman AT, Reyes CM, Sundeen RE, Post KD (2004) Significance of “Abnormal” Nadir growth hormone levels after oral glucose in postoperative patients with acromegaly in remission with normal insulin-like growth factor-i levels. J Clin Endocrinol Metab 89(2):495–500

    Article  CAS  PubMed  Google Scholar 

  8. Freda PU, Post KD, Powell JS, Wardlaw SL (1998) Evaluation of disease status with sensitive measures of growth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 83(11):3808–3816

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  CAS  PubMed  Google Scholar 

  10. Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, Casanueva FF, Trainer P, Ghigo E, Ho K, Melmed S (2010) A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab

  11. Graham KE, Samuels MH, Raff H, Barnwell SL, Cook DM (1997) Intraoperative adrenocorticotropin levels during transsphenoidal surgery for Cushing’s disease do not predict cure. J Clin Endocrinol Metab 82(6):1776–1779

    Article  CAS  PubMed  Google Scholar 

  12. Kauppinen-Makelin R, Sane T, Sintonen H, Markkanen H, Valimaki MJ, Loyttyniemi E, Niskanen L, Reunanen A, Stenman UH (2006) Quality of life in treated patients with acromegaly. J Clin Endocrinol Metab 91(10):3891–3896

    Article  CAS  PubMed  Google Scholar 

  13. Kreutzer J, Vance ML, Lopes MB, Laws ER Jr (2001) Surgical management of gh-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab 86(9):4072–4077

    Article  CAS  PubMed  Google Scholar 

  14. Kristof RA, Neuloh G, Redel L, Klingmuller 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

    Article  PubMed  Google Scholar 

  15. Kristof RA, Schramm J, Redel L, Neuloh G, Wichers M, Klingmuller D (2002) Endocrinological outcome following first time transsphenoidal surgery for gh-, acth-, and prl-secreting pituitary adenomas. Acta Neurochir (Wien) 144(6):555–561, discussion 561

    Article  CAS  Google Scholar 

  16. Laws ER, Vance ML, Thapar K (2000) Pituitary surgery for the management of acromegaly. Horm Res 53(Suppl 3):71–75

    Article  CAS  PubMed  Google Scholar 

  17. Losa M, Oeckler R, Schopohl J, Muller OA, Alba-Lopez J, von Werder K (1989) Evaluation of selective transsphenoidal adenomectomy by endocrinological testing and somatomedin-c measurement in acromegaly. J Neurosurg 70(4):561–567

    Article  CAS  PubMed  Google Scholar 

  18. 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 (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517

    Article  CAS  PubMed  Google Scholar 

  19. Minniti G, Jaffrain-Rea ML, Esposito V, Santoro A, Tamburrano G, Cantore G (2003) Evolving criteria for post-operative biochemical remission of acromegaly: can we achieve a definitive cure? An audit of surgical results on a large series and a review of the literature. Endocr Relat Cancer 10(4):611–619

    Article  CAS  PubMed  Google Scholar 

  20. Owens D, Srivastava MC, Tompkins CV, Nabarro JD, Sonksen PH (1973) Studies on the metabolic clearance rate, apparent distribution space and plasma half-disappearance time of unlabelled human growth hormone in normal subjects and in patients with liver disease, renal disease, thyroid disease and diabetes mellitus. Eur J Clin Invest 3(4):284–294

    Article  CAS  PubMed  Google Scholar 

  21. Parfitt VJ, Flanagan D, Wood P, Leatherdale BA (1998) Outpatient assessment of residual growth hormone secretion in treated acromegaly with overnight urinary growth hormone excretion, random serum growth hormone and insulin like growth factor-1. Clin Endocrinol (Oxf) 49(5):647–652

    Article  CAS  Google Scholar 

  22. Peacey SR, Shalet SM (2001) Insulin-like growth factor 1 measurement in diagnosis and management of acromegaly. Ann Clin Biochem 38(Pt 4):297–303

    Article  CAS  PubMed  Google Scholar 

  23. Ronchi CL, Varca V, Giavoli C, Epaminonda P, Beck-Peccoz P, Spada A, Arosio M (2005) Long-term evaluation of postoperative acromegalic patients in remission with previous and newly proposed criteria. J Clin Endocrinol Metab 90(3):1377–1382

    Article  CAS  PubMed  Google Scholar 

  24. Sackett DL, Straus S (1998) On some clinically useful measures of the accuracy of diagnostic tests. ACP J Club 129(2):A17–A19

    CAS  PubMed  Google Scholar 

  25. Stoffel-Wagner B, Springer W, Bidlingmaier F, Klingmuller D (1997) A comparison of different methods for diagnosing acromegaly. Clin Endocrinol (Oxf) 46(5):531–537

    Article  CAS  Google Scholar 

  26. Thorner MV, Jr. LE (1998) The anterior pituitary. In: Wilke JF, Kronenberg HM, Larsen PR (eds) Williams textbook of endocrinology 9th edn. Saunders, New York, pp 249–340

  27. Trainer PJ (2002) Editorial: acromegaly–consensus, what consensus? J Clin Endocrinol Metab 87(8):3534–3536

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, University of Bonn, Sigmund Freud Str. 25, 53105, Bonn, Germany

    Rudolf A. Kristof, Alexander Grote, Georg Neuloh & Johannes Schramm

  2. Institute of Clinical Biochemistry, University of Bonn, Sigmund Freud Str. 25, 53105, Bonn, Germany

    Lioba Redel & Dietrich Klingmüller

Authors
  1. Rudolf A. Kristof
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  2. Alexander Grote
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  3. Lioba Redel
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  4. Georg Neuloh
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  5. Dietrich Klingmüller
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  6. Johannes Schramm
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Correspondence to Alexander Grote.

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Kristof, R.A., Grote, A., Redel, L. et al. The common consensus criteria have high predictive values for long-term postoperative acromegaly remission. Acta Neurochir 153, 19–25 (2011). https://doi.org/10.1007/s00701-010-0790-7

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  • DOI: https://doi.org/10.1007/s00701-010-0790-7

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