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Surgery induced hypopituitarism in acromegalic patients: a systematic review and meta-analysis of the results

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Abstract

Purpose

Hypopituitarism is a possible complication of the surgical treatment of acromegaly. However, there is a wide variability in the incidence rates of surgery-induced hypopituitarism. The purpose of this study was the systematic collection and synthesis of information on the incidence rates of hypopituitarism, panhypopituitarism, specific axis deficiencies and diabetes insipidus after surgery for acromegaly treatment.

Methods

We systematically reviewed all the papers that have reported pituitary deficits after surgery for acromegaly published up until December 2014, in the PubMed database. We identified 92 studies enrolling 6988 patients. A meta-analysis was performed to evaluate the incidence rates. We also performed several subgroup analyses to evaluate the impact of both surgical technique, and treatment prior to surgery, on the results.

Results

The weighted incidence rates were 12.79 % for hypopituitarism (95 % CI 9.88–16.00 %), 2.50 % for panhypopituitarism (95 % CI 1.24–4.15 %), 6.50 % for ACTH deficiency (95 % CI 4.07–9.44 %), 4.39 % for TSH deficiency (95 % CI 2.99–6.04 %), 6.70 % for FSH/LH deficiency (95 % CI 3.89–10.17 %), 14.95 % for GH deficiency (95 % CI 7.25–24.64 %), 10.05 % for transient (95 % CI 7.18–13.33 %) and 2.42 % for permanent diabetes insipidus (95 % CI 1.70–3.27 %).

Conclusion

Our study provides new data on the incidence rates of hypopituitarism, specific pituitary axis deficiencies and diabetes insipidus after surgical treatment of acromegaly. Somatotroph function appears to be more prone to deficit than the other axes. However, there is a high heterogeneity between studies and several factors may influence the incidence of hypopituitarism.

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References

  1. Melmed S (2006) Medical progress: acromegaly. N Engl J Med 355(24):2558–2573. doi:10.1056/NEJMra062453

    Article  CAS  PubMed  Google Scholar 

  2. Holdaway IM, Rajasoorya C (1999) Epidemiology of acromegaly. Pituitary 2(1):29–41

    Article  CAS  PubMed  Google Scholar 

  3. 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 95(7):3141–3148. doi:10.1210/jc.2009-2670

    Article  CAS  PubMed  Google Scholar 

  4. Laws ER (2008) Surgery for acromegaly: evolution of the techniques and outcomes. Rev Endocr Metab Disord 9(1):67–70. doi:10.1007/s11154-007-9064-y

    Article  PubMed  Google Scholar 

  5. 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. doi:10.1210/jc.2008-2421

    Article  CAS  PubMed  Google Scholar 

  6. Marquez Y, Tuchman A, Zada G (2012) Surgery and radiosurgery for acromegaly: a review of indications, operative techniques, outcomes, and complications. Int J Endocrinol 2012:386401. doi:10.1155/2012/386401

    Article  PubMed Central  PubMed  Google Scholar 

  7. Schneider HJ, Aimaretti G, Kreitschmann-Andermahr I, Stalla GK, Ghigo E (2007) Hypopituitarism. Lancet 369(9571):1461–1470. doi:10.1016/s0140-6736(07)60673-4

    Article  CAS  PubMed  Google Scholar 

  8. Ascoli P, Cavagnini F (2006) Hypopituitarism. Pituitary 9(4):335–342. doi:10.1007/s11102-006-0416-5

    Article  CAS  PubMed  Google Scholar 

  9. Devin JK (2012) Hypopituitarism and central diabetes insipidus: perioperative diagnosis and management. Neurosurg Clin N Am 23(4):679–689. doi:10.1016/j.nec.2012.06.001

    Article  PubMed  Google Scholar 

  10. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T (2013) Meta-analysis of prevalence. J Epidemiol Community Health 67(11):974–978. doi:10.1136/jech-2013-203104

    Article  PubMed  Google Scholar 

  11. Neyeloff J, Fuchs S, Moreira L (2012) Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5(1):52

    Article  PubMed Central  PubMed  Google Scholar 

  12. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. doi:10.1136/bmj.327.7414.557

    Article  PubMed Central  PubMed  Google Scholar 

  13. Inder WJ, Espiner EA, MacFarlane MR (2003) Outcome from surgical management of secretory pituitary adenomas in Christchurch. N Z Intern Med J 33(4):168–173

    Article  CAS  Google Scholar 

  14. Kaplan FJ, Levitt NS, De Villiers JC, Soule SG (2001) Acromegaly in the developing world–a 20-year teaching hospital experience. Br J Neurosurg 15(1):22–27

    Article  CAS  PubMed  Google Scholar 

  15. 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. doi:10.1210/jcem.86.9.7819

    Article  CAS  PubMed  Google Scholar 

  16. 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/Eur Fed Endocr Soc 152(3):379–387. doi:10.1530/eje.1.01863

    Article  CAS  Google Scholar 

  17. Takahashi JA, Shimatsu A, Nakao K, Hashimoto N (2004) Early postoperative indicators of late outcome in acromegalic patients. Clin Endocrinol 60(3):366–374

    Article  Google Scholar 

  18. Valdemarsson S, Bramnert M, Cronquist S, Elner A, Eneroth CM, Hedner P, Lindvall-Axelsson M, Nordstrom CH, Stromblad LG (1991) Early postoperative basal serum GH level and the GH response to TRH in relation to the long-term outcome of surgical treatment for acromegaly: a report on 39 patients. J Intern Med 230(1):49–54

    Article  CAS  PubMed  Google Scholar 

  19. van Lindert E, Hey O, Boecher-Schwarz H, Perneczky A (1997) Treatment results of acromegaly as analyzed by different criteria. Acta neurochirurgica 139(10): 905–912; discussion 912-903

  20. Van Rompaey K, Unuane D, Moens M, Duerinck J, Poppe K, Velkeniers B, D’Haens J (2013) Long-term follow-up results of multimodal treatment with initial surgical approach for acromegaly in a single center. Acta Neurol Belg 113(1):49–54. doi:10.1007/s13760-012-0128-8

    Article  PubMed  Google Scholar 

  21. Yamada S, Fukuhara N, Oyama K, Takeshita A, Takeuchi Y (2010) Repeat transsphenoidal surgery for the treatment of remaining or recurring pituitary tumors in acromegaly. Neurosurgery 67(4):949–956. doi:10.1227/NEU.0b013e3181ec4379

    Article  PubMed  Google Scholar 

  22. Albarel F, Castinetti F, Morange I, Conte-Devolx B, Gaudart J, Dufour H, Brue T (2013) Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients. Clin Endocrinol 78(2):263–270. doi:10.1111/j.1365-2265.2012.04492.x

    Article  CAS  Google Scholar 

  23. Attanasio R, Montini M, Valota M, Cortesi L, Barbo R, Biroli F, Tonnarelli G, Albizzi M, Testa RM, Pagani G (2008) An audit of treatment outcome in acromegalic patients attending our center at Bergamo, Italy. Pituitary 11(1):1–11. doi:10.1007/s11102-007-0059-1

    Article  PubMed  Google Scholar 

  24. Arafah BU, Brodkey JS, Kaufman B, Velasco M, Manni A, Pearson OH (1980) Transsphenoidal microsurgery in the treatment of acromegaly and gigantism. J Clin Endocrinol Metab 50(3):578–585. doi:10.1210/jcem-50-3-578

    Article  CAS  PubMed  Google Scholar 

  25. 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. doi:10.1210/jc.2002-021822

    Article  CAS  PubMed  Google Scholar 

  26. Ludecke D, Kautzky R, Saeger W, Schrader D (1976) Selective removal of hypersecreting pituitary adenomas? An analysis of endocrine function, operative and microscopical findings in 101 cases. Acta Neurochir 35(1–3):27–42

    Article  CAS  PubMed  Google Scholar 

  27. Tucker HS, Grubb SR, Wigand JP, Watlington CO, Blackard WG, Becker DP (1980) The treatment of acromegaly by transsphenoidal surgery. Arch Intern Med 140(6):795–802

    Article  CAS  PubMed  Google Scholar 

  28. Ahmed S, Elsheikh M, Stratton IM, Page RC, Adams CB, Wass JA (1999) Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience. Clin Endocrinol 50(5):561–567

    Article  CAS  Google Scholar 

  29. Ronchi CL, Giavoli C, Ferrante E, Verrua E, Bergamaschi S, Ferrari DI, Corbetta S, Montefusco L, Arosio M, Ambrosi B, Spada A, Beck-Peccoz P (2009) Prevalence of GH deficiency in cured acromegalic patients: impact of different previous treatments. Eur J Endocrinol/Eur Fed Endocr Soc 161(1):37–42. doi:10.1530/eje-09-0222

    Article  CAS  Google Scholar 

  30. Krzentowska-Korek A, Golkowski F, Baldys-Waligorska A, Hubalewska-Dydejczyk A (2011) Efficacy and complications of neurosurgical treatment of acromegaly. Pituitary 14(2):157–162. doi:10.1007/s11102-010-0273-0

    Article  PubMed  Google Scholar 

  31. Rosen T, Bengtsson BA (1990) Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 336(8710):285–288

    Article  CAS  PubMed  Google Scholar 

  32. Gao Y, Zhong C, Wang Y, Xu S, Guo Y, Dai C, Zheng Y, Wang Y, Luo Q, Jiang J (2014) Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis. World J Surg Oncol 12:94. doi:10.1186/1477-7819-12-94

    Article  PubMed Central  PubMed  Google Scholar 

  33. Ammirati M, Wei L, Ciric I (2013) Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 84(8):843–849. doi:10.1136/jnnp-2012-303194

    Article  PubMed Central  PubMed  Google Scholar 

  34. Long H, Beauregard H, Somma M, Comtois R, Serri O, Hardy J (1996) Surgical outcome after repeated transsphenoidal surgery in acromegaly. J Neurosurg 85(2):239–247. doi:10.3171/jns.1996.85.2.0239

    Article  CAS  PubMed  Google Scholar 

  35. Laws ER Jr, Fode NC, Redmond MJ (1985) Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients. J Neurosurg 63(6):823–829. doi:10.3171/jns.1985.63.6.0823

    Article  PubMed  Google Scholar 

  36. Ku CR, Kim EH, Oh MC, Lee EJ, Kim SH (2012) Surgical and endocrinological outcomes in the treatment of growth hormone-secreting pituitary adenomas according to the shift of surgical paradigm. Neurosurgery 71(2 Suppl Operative):192–203; discussion ons203 doi:10.1227/NEU.0b013e318265a288

  37. Ciric I, Ragin A, Baumgartner C, Pierce D (1997) Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 40(2):225–236; discussion 236-227

  38. Kabil MS, Eby JB, Shahinian HK (2005) Fully endoscopic endonasal versus transseptal transsphenoidal pituitary surgery. Minim Invasive Neurosurg : MIN 48(6):348–354 doi:10.1055/s-2005-915635

  39. Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83(3–4):240–248. doi:10.1159/000095534

    Article  CAS  PubMed  Google Scholar 

  40. Zada G, Kelly DF, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98(2):350–358. doi:10.3171/jns.2003.98.2.0350

    Article  PubMed  Google Scholar 

  41. Leach P, Abou-Zeid AH, Kearney T, Davis J, Trainer PJ, Gnanalingham KK (2010) Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery 67(5):1205–1212. doi:10.1227/NEU.0b013e3181ef25c5

    Article  PubMed  Google Scholar 

  42. Roelfsema F, Biermasz NR, Pereira AM (2012) Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. Pituitary 15(1):71–83. doi:10.1007/s11102-011-0347-7

    Article  PubMed Central  PubMed  Google Scholar 

  43. Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001) Association between premature mortality and hypopituitarism. West Midlands Prospective Hypopituitary Study Group. Lancet 357(9254):425–431

    Article  CAS  PubMed  Google Scholar 

  44. Yamada S, Fukuhara N, Nishioka H, Takeshita A, Suzuki H, Miyakawa M, Takeuchi Y (2011) GH deficiency in patients after cure of acromegaly by surgery alone. Eur J Endocrinol/Eur Fed Endocr Soc 165(6):873–879. doi:10.1530/eje-11-0657

    Article  CAS  Google Scholar 

  45. Ausiello JC, Bruce JN, Freda PU (2008) Postoperative assessment of the patient after transsphenoidal pituitary surgery. Pituitary 11(4):391–401. doi:10.1007/s11102-008-0086-6

    Article  PubMed  Google Scholar 

  46. Abe T, Ludecke DK (1999) Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly. Clin Endocrinol 50(1):27–35

    Article  CAS  Google Scholar 

  47. Abe T, Ludecke DK (2001) Effects of preoperative octreotide treatment on different subtypes of 90 GH-secreting pituitary adenomas and outcome in one surgical centre. Eur J Endocrinol/Eur Fed Endocr Soc 145(2):137–145

    Article  CAS  Google Scholar 

  48. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1998) Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 83(10):3411–3418. doi:10.1210/jcem.83.10.5111

    Article  CAS  PubMed  Google Scholar 

  49. Atkinson RL, Becker DP, Martins AN, Schaaf M, Dimond RC, Wartofsky L, Earll JM (1975) Acromegaly. Treatment by transsphenoidal microsurgery. JAMA 233(12):1279–1283

    Article  CAS  PubMed  Google Scholar 

  50. Baskin DS, Boggan JE, Wilson CB (1982) Transsphenoidal microsurgical removal of growth hormone-secreting pituitary adenomas. A review of 137 cases. J Neurosurg 56(5):634–641. doi:10.3171/jns.1982.56.5.0634

    Article  CAS  PubMed  Google Scholar 

  51. Bellut D, Hlavica M, Schmid C, Bernays RL (2010) Intraoperative magnetic resonance imaging-assisted transsphenoidal pituitary surgery in patients with acromegaly. Neurosurg Focus 29(4):E9. doi:10.3171/2010.7.focus10164

    Article  PubMed  Google Scholar 

  52. Berkmann S, Fandino J, Muller B, Kothbauer KF, Henzen C, Landolt H (2012) Pituitary surgery: experience from a large network in Central Switzerland. Swiss Med Wkly 142:w13680. doi:10.4414/smw.2012.13680

    PubMed  Google Scholar 

  53. Biermasz NR, van Dulken H, Roelfsema F (1999) Direct postoperative and follow-up results of transsphenoidal surgery in 19 acromegalic patients pretreated with octreotide compared to those in untreated matched controls. J Clin Endocrinol Metab 84(10):3551–3555. doi:10.1210/jcem.84.10.6027

    Article  CAS  PubMed  Google Scholar 

  54. 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. doi:10.1210/jcem.85.12.7042

    Article  CAS  PubMed  Google Scholar 

  55. Bourdelot A, Coste J, Hazebroucq V, Gaillard S, Cazabat L, Bertagna X, Bertherat J (2004) Clinical, hormonal and magnetic resonance imaging (MRI) predictors of transsphenoidal surgery outcome in acromegaly. Eur J Endocrinol/Eur Fed Endoc Soc 150(6):763–771

    Article  CAS  Google Scholar 

  56. Burgers AM, Kokshoorn NE, Pereira AM, Roelfsema F, Smit JW, Biermasz NR, Romijn JA (2011) Low incidence of adrenal insufficiency after transsphenoidal surgery in patients with acromegaly: a long-term follow-up study. J Clin Endocrinol Metab 96(7):E1163–E1170. doi:10.1210/jc.2010-2673

    Article  PubMed  Google Scholar 

  57. Campbell PG, Kenning E, Andrews DW, Yadla S, Rosen M, Evans JJ (2010) Outcomes after a purely endoscopic transsphenoidal resection of growth hormone-secreting pituitary adenomas. Neurosurg Focus 29(4):E5. doi:10.3171/2010.7.focus10153

    Article  PubMed  Google Scholar 

  58. Cappabianca P, Alfieri A, Colao A, Ferone D, Lombardi G, de Divitiis E (1999) Endoscopic endonasal transsphenoidal approach: an additional reason in support of surgery in the management of pituitary lesions. Skull Base Surg 9(2):109–117

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Chandna A, Islam N, Jabbar A, Zuberi L, Haque N (2004) Clinical features and outcome of surgery in 30 patients with acromegaly. JPMA J Pak Med Assoc 54(6):315–319

    CAS  PubMed  Google Scholar 

  60. Colao A, Attanasio R, Pivonello R, Cappabianca P, Cavallo LM, Lasio G, Lodrini A, Lombardi G, Cozzi R (2006) Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly. J Clin Endocrinol Metab 91(1):85–92. doi:10.1210/jc.2005-1208

    Article  CAS  PubMed  Google Scholar 

  61. 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 versus surgery in newly diagnosed patients with acromegaly: a randomized, open-label, multicentre study. Clin Endocrinol 70(5):757–768. doi:10.1111/j.1365-2265.2008.03441.x

    Article  Google Scholar 

  62. Conceicao FL, Fisker S, Andersen M, Kaal A, Jorgensen JO, Vaisman M, Christiansen JS (2003) Evaluation of growth hormone stimulation tests in cured acromegalic patients. Growth Horm & IGF Res 13(6):347–352

    Article  CAS  Google Scholar 

  63. Demir O, Gedik V, Corapcioglu D, Emral R, Unlu MA, Erdogan MF, Gullu S, Uysal AR, Baskal N (2012) Improvement in remission rates of the first operation in acromegalic patients. Turk Neurosurg 22(5):645–650. doi:10.5137/1019-5149.jtn.6045-12.0

    PubMed  Google Scholar 

  64. Dusek T, Kastelan D, Melada A, Baretic M, Polovina TS, Perkovic Z, Giljevic Z, Jelcic J, Paladino J, Aganovic I, Korsic M (2011) Clinical features and therapeutic outcomes of patients with acromegaly: single-center experience. J Endocrinol Investig 34(11):e382–e385. doi:10.3275/7858

    CAS  Google Scholar 

  65. Freda PU, Wardlaw SL, Post KD (1998) Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 89(3):353–358. doi:10.3171/jns.1998.89.3.0353

    Article  CAS  PubMed  Google Scholar 

  66. Fujio S, Tokimura H, Hirano H, Hanaya R, Kubo F, Yunoue S, Bohara M, Kinoshita Y, Tominaga A, Arimura H, Arita K (2013) Severe growth hormone deficiency is rare in surgically-cured acromegalics. Pituitary 16(3):326–332. doi:10.1007/s11102-012-0424-6

    PubMed Central  CAS  PubMed  Google Scholar 

  67. Fukuda I, Hizuka N, Murakami Y, Itoh E, Yasumoto K, Sata A, Takano K (2001) Clinical features and therapeutic outcomes of 65 patients with acromegaly at Tokyo Women’s Medical University. Intern Med (Tokyo, Japan) 40(10):987–992

    Article  CAS  Google Scholar 

  68. Geelhoed-Duijvestijn PH, Bussemaker JK, Roelfsema F (1989) Changes in basal and stimulated TSH and other parameters of thyroid function in acromegaly after transsphenoidal surgery. Acta Endocrinol 121(2):207–215

    CAS  PubMed  Google Scholar 

  69. Gittoes NJ, Sheppard MC, Johnson AP, Stewart PM (1999) Outcome of surgery for acromegaly–the experience of a dedicated pituitary surgeon. QJM : Mon J Assoc Physicians 92(12):741–745

    Article  CAS  Google Scholar 

  70. Gondim JA, Almeida JP, de Albuquerque LA, Gomes E, Schops M, Ferraz T (2010) Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurg Focus 29(4):E7. doi:10.3171/2010.7.focus10167

    Article  PubMed  Google Scholar 

  71. Greenman Y, Tordjman K, Kisch E, Razon N, Ouaknine G, Stern N (1995) Relative sparing of anterior pituitary function in patients with growth hormone-secreting macroadenomas: comparison with nonfunctioning macroadenomas. J Clin Endocrinol Metab 80(5):1577–1583. doi:10.1210/jcem.80.5.7745003

    CAS  PubMed  Google Scholar 

  72. Grisoli F, Leclercq T, Jaquet P, Guibout M, Winteler JP, Hassoun J, Vincentelli F (1985) Transsphenoidal surgery for acromegaly–long-term results in 100 patients. Surg Neurol 23(5):513–519

    Article  CAS  PubMed  Google Scholar 

  73. Hazer DB, Isik S, Berker D, Guler S, Gurlek A, Yucel T, Berker M (2013) Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg 119(6):1467–1477. doi:10.3171/2013.8.jns13224

    Article  PubMed  Google Scholar 

  74. Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M (1999) Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol 50(4):431–439

    Article  CAS  Google Scholar 

  75. Hofstetter CP, Mannaa RH, Mubita L, Anand VK, Kennedy JW, Dehdashti AR, Schwartz TH (2010) Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurg Focus 29(4):E6. doi:10.3171/2010.7.focus10173

    Article  PubMed  Google Scholar 

  76. Hofstetter CP, Shin BJ, Mubita L, Huang C, Anand VK, Boockvar JA, Schwartz TH (2011) Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus 30(4):E10. doi:10.3171/2011.1.focus10317

    Article  PubMed  Google Scholar 

  77. Jaffrain-Rea ML, Minniti G, Moroni C, Esposito V, Ferretti E, Santoro A, Infusino T, Tamburrano G, Cantore G, Cassone R (2003) Impact of successful transsphenoidal surgery on cardiovascular risk factors in acromegaly. Eur J Endocrinol/Eur Fed Endocr Soc 148(2):193–201

    Article  CAS  Google Scholar 

  78. Jakobsson KE, Petruson B, Elfverson J, Bengtsson BA (1995) Results of the lateral rhinotomy approach in transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma. Br J Neurosurg 9(6):763–768

    Article  CAS  PubMed  Google Scholar 

  79. Jane JA Jr, Starke RM, Elzoghby MA, Reames DL, Payne SC, Thorner MO, Marshall JC, Laws ER Jr, Vance ML (2011) Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab 96(9):2732–2740. doi:10.1210/jc.2011-0554

    Article  CAS  PubMed  Google Scholar 

  80. Karaca Z, Tanriverdi F, Elbuken G, Cakir I, Donmez H, Selcuklu A, Durak AC, Dokmetas HS, Colak R, Unluhizarci K, Kelestimur F (2011) Comparison of primary octreotide-lar and surgical treatment in newly diagnosed patients with acromegaly. Clin Endocrinol 75(5):678–684. doi:10.1111/j.1365-2265.2011.04106.x

    Article  CAS  Google Scholar 

  81. Kawamata T, Kubo O, Hori T (2005) Surgical removal of growth hormone-secreting pituitary adenomas with intensive microsurgical pseudocapsule resection results in complete remission of acromegaly. Neurosurg Rev 28(3):201–208. doi:10.1007/s10143-005-0384-7

    Article  PubMed  Google Scholar 

  82. Kim MS, Jang HD, Kim OL (2009) Surgical results of growth hormone-secreting pituitary adenoma. J Korean Neurosurg Soc 45(5):271–274. doi:10.3340/jkns.2009.45.5.271

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  83. Kristof RA, Stoffel-Wagner B, Klingmuller D, Schramm J (1999) Does octreotide treatment improve the surgical results of macro-adenomas in acromegaly? A randomized study. Acta Neurochir 141(4):399–405

    Article  CAS  PubMed  Google Scholar 

  84. Ku CR, Hong JW, Kim EH, Kim SH, Lee EJ (2014) Clinical predictors of GH deficiency in surgically cured acromegalic patients. Eur J Endocrinol/Eur Fed Endocr Soc 171(3):379–387. doi:10.1530/eje-14-0304

    Article  CAS  Google Scholar 

  85. Kurosaki M, Luedecke DK, Abe T (2003) Effectiveness of secondary transnasal surgery in GH-secreting pituitary macroadenomas. Endocr J 50(5):635–642

    Article  PubMed  Google Scholar 

  86. Lampropoulos KI, Samonis G, Nomikos P (2013) Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: a study on 184 patients. Hormones (Athens, Greece) 12(2):254–264

    Article  Google Scholar 

  87. Li ZQ, Quan Z, Tian HL, Cheng M (2012) Preoperative lanreotide treatment improves outcome in patients with acromegaly resulting from invasive pituitary macroadenoma. J Int Med Res 40(2):517–524

    Article  CAS  PubMed  Google Scholar 

  88. Losa M, Mortini P, Urbaz L, Ribotto P, Castrignano T, Giovanelli M (2006) Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates. J Neurosurg 104(6):899–906. doi:10.3171/jns.2006.104.6.899

    Article  CAS  PubMed  Google Scholar 

  89. Maric A, Kruljac I, Cerina V, Pecina HI, Sulentic P, Vrkljan M (2012) Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian referral pituitary center experience. Croat Med J 53(3):224–233

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  90. Minniti G, Jaffrain-Rea ML, Esposito V, Santoro A, Moroni C, Lenzi J, Tamburrano G, Cassone R, Cantore G (2001) Surgical treatment and clinical outcome of GH-secreting adenomas in elderly patients. Acta Neurochir 143(12):1205–1211. doi:10.1007/s007010100015

    Article  CAS  PubMed  Google Scholar 

  91. Minniti G, Moroni C, Jaffrain-Rea ML, Esposito V, Santoro A, Affricano C, Cantore G, Tamburrano G, Cassone R (2001) Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients. Clin Endocrinol 55(3):307–313

    Article  CAS  Google Scholar 

  92. Mukherjee JJ, de Castro JJ, Kaltsas G, Afshar F, Grossman AB, Wass JA, Besser GM (1997) A comparison of the insulin tolerance/glucagon test with the short ACTH stimulation test in the assessment of the hypothalamo-pituitary-adrenal axis in the early post-operative period after hypophysectomy. Clin Endocrinol 47(1):51–60

    Article  CAS  Google Scholar 

  93. Murray RD, Peacey SR, Rahim A, Toogood AA, Thorner MO, Shalet SM (2001) The diagnosis of growth hormone deficiency (GHD) in successfully treated acromegalic patients. Clin Endocrinol 54(1):37–44

    Article  CAS  Google Scholar 

  94. Osman IA, James RA, Chatterjee S, Mathias D, Kendall-Taylor P (1994) Factors determining the long-term outcome of surgery for acromegaly. QJM : Mon J Assoc Physicians 87(10):617–623

    CAS  Google Scholar 

  95. Oyen WJ, Pieters GF, Meijer E, Laarhoven JV, Smals AG, Kloppenborg PW (1988) Which factors predict the results of pituitary surgery in acromegaly? Acta Endocrinol 117(4):491–496

  96. Pekic S, Doknic M, Miljic D, Joksimovic M, Glodic J, Djurovic M, Dieguez C, Casanueva F, Popovic V (2006) Ghrelin test for the assessment of GH status in successfully treated patients with acromegaly. Eur J Endocrinol/Eur Fed Endocr Soc 154(5):659–666. doi:10.1530/eje.1.02148

    Article  CAS  Google Scholar 

  97. Plockinger U, Quabbe HJ (2005) Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study. Acta Neurochir 147(5):485–493; discussion 493 (2005). doi:10.1007/s00701-005-0511-9

  98. Quabbe HJ (1982) Treatment of acromegaly by trans-sphenoidal operation, 90-yttrium implantation and bromocriptine: results in 230 patients. Clin Endocrinol 16(2):107–119

    Article  CAS  Google Scholar 

  99. Roelfsema F, van Dulken H, Frolich M (1985) Long-term results of transsphenoidal pituitary microsurgery in 60 acromegalic patients. Clin Endocrinol 23(5):555–565

    Article  CAS  Google Scholar 

  100. Ronchi CL, Ferrante E, Rizzo E, Giavoli C, Verrua E, Bergamaschi S, Lania AG, Beck-Peccoz P, Spada A (2008) Long-term basal and dynamic evaluation of hypothalamic-pituitary-adrenal (HPA) axis in acromegalic patients. Clin Endocrinol 69(4):608–612. doi:10.1111/j.1365-2265.2008.03270.x

    Article  CAS  Google Scholar 

  101. Ross DA, Wilson CB (1988) Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 68(6):854–867. doi:10.3171/jns.1988.68.6.0854

    Article  CAS  PubMed  Google Scholar 

  102. Sala E, Ferrante E, Locatelli M, Rampini P, Mantovani G, Giavoli C, Filopanti M, Verrua E, Malchiodi E, Carrabba G, Arosio M, Beck-Peccoz P, Spada A, Lania AG (2014) Diagnostic features and outcome of surgical therapy of acromegalic patients: experience of the last three decades. Hormones (Athens) 13(1):95–103

  103. Sheaves R, Jenkins P, Blackburn P, Huneidi AH, Afshar F, Medbak S, Grossman AB, Besser GM, Wass JA (1996) Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure. Clin Endocrinol 45(4):407–413

    Article  CAS  Google Scholar 

  104. Shin SS, Tormenti MJ, Paluzzi A, Rothfus WE, Chang YF, Zainah H, Fernandez-Miranda JC, Snyderman CH, Challinor SM, Gardner PA (2013) Endoscopic endonasal approach for growth hormone secreting pituitary adenomas: outcomes in 53 patients using 2010 consensus criteria for remission. Pituitary 16(4):435–444. doi:10.1007/s11102-012-0440-6

    Article  CAS  PubMed  Google Scholar 

  105. Shirvani M, Motiei-Langroudi R (2014) Transsphenoidal surgery for growth hormone-secreting pituitary adenomas in 130 patients. World Neurosurg 81(1):125–130. doi:10.1016/j.wneu.2013.01.021

    Article  PubMed  Google Scholar 

  106. Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA Jr (2013) Endoscopic versus microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab 98(8):3190–3198. doi:10.1210/jc.2013-1036

    Article  CAS  PubMed  Google Scholar 

  107. Sun H, Brzana J, Yedinak CG, Gultekin SH, Delashaw JB, Fleseriu M (2014) Factors associated with biochemical remission after microscopic transsphenoidal surgery for acromegaly. J Neurol Surg Part B Skull Base 75(1):47–52. doi:10.1055/s-0033-1354578

    Article  Google Scholar 

  108. Swearingen B, Barker FG 2nd, Katznelson L, Biller BM, Grinspoon S, Klibanski A, Moayeri N, Black PM, Zervas NT (1998) Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 83(10):3419–3426. doi:10.1210/jcem.83.10.5222

    CAS  PubMed  Google Scholar 

  109. Teasdale GM, Hay ID, Beasttall GH, McCruden DC, Thomson JA, Davies DL, Grossart KW, Ratcliffe JG (1982) Cryosurgery or microsurgery in the management of acromegaly. JAMA 247(9):1289–1291

    Article  CAS  PubMed  Google Scholar 

  110. U HS, Wilson CB, Tyrrell JB (1977) Transsphenoidal microhypophysectomy in acromegaly. J Neurosurg 47(6):840–852. doi:10.3171/jns.1977.47.6.0840

    Article  CAS  PubMed  Google Scholar 

  111. Valdemarsson S, Ljunggren S, Bramnert M, Norrhamn O, Nordstrom CH (2000) Early postoperative growth hormone levels: high predictive value for long-term outcome after surgery for acromegaly. J Intern Med 247(6):640–650

    Article  CAS  PubMed  Google Scholar 

  112. van Bunderen CC, van Varsseveld NC, Baayen JC, van Furth WR, Aliaga ES, Hazewinkel MJ, Majoie CB, Freling NJ, Lips P, Fliers E, Bisschop PH, Drent ML (2013) Predictors of endoscopic transsphenoidal surgery outcome in acromegaly: patient and tumor characteristics evaluated by magnetic resonance imaging. Pituitary 16(2):158–167. doi:10.1007/s11102-012-0395-7

    Article  PubMed Central  PubMed  Google Scholar 

  113. van’t Verlaat JW, Nortier JW, Hendriks MJ, Bosma NJ, Graamans K, Lubsen H, Vasen HF, Thijssen JH, Croughs RJ (1988) Transsphenoidal microsurgery as primary treatment in 25 acromegalic patients: results and follow-up. Acta Endocrinol 117(2):154–158

    PubMed  Google Scholar 

  114. Wagenmakers MA, Netea-Maier RT, van Lindert EJ, Pieters GF, Grotenhuis AJ, Hermus AR (2011) Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma. Acta Neurochir 153(7):1391–1399. doi:10.1007/s00701-011-0959-8

    Article  PubMed Central  PubMed  Google Scholar 

  115. Wang YY, Higham C, Kearney T, Davis JR, Trainer P, Gnanalingham KK (2012) Acromegaly surgery in Manchester revisited–the impact of reducing surgeon numbers and the 2010 consensus guidelines for disease remission. Clin Endocrinol 76(3):399–406. doi:10.1111/j.1365-2265.2011.04193.x

    Article  CAS  Google Scholar 

  116. Yamada S, Takada K, Ozawa Y, Shimizu T, Sawano S, Shishiba Y, Sano T, Usui M (1997) The results of transsphenoidal surgery for 44 consecutive acromegalic patients. Endocr J 44(3):395–402

    Article  CAS  PubMed  Google Scholar 

  117. Zada G, Cavallo LM, Esposito F, Fernandez-Jimenez JC, Tasiou A, De Angelis M, Cafiero T, Cappabianca P, Laws ER (2010) Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations. Neurosurg Focus 29(4):E8. doi:10.3171/2010.8.focus10156

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Pedro Carvalho, Eva Lau & Davide Carvalho

  2. Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar S. João, Alameda Professor Hernâni Monteiro, 4200–319, Porto, Portugal

    Eva Lau & Davide Carvalho

  3. Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal

    Eva Lau & Davide Carvalho

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Carvalho, P., Lau, E. & Carvalho, D. Surgery induced hypopituitarism in acromegalic patients: a systematic review and meta-analysis of the results. Pituitary 18, 844–860 (2015). https://doi.org/10.1007/s11102-015-0661-6

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