Effect of transnasal transsphenoidal surgery on acromegaly caused by pituitary adenoma and its early biochemical index remission factors

Abstract

Objective To study the clinical efficacy of transnasal transsphenoidal surgery in acromegaly caused by pituitary adenoma and the clinical characteristics of patients achieved early biochemical remission after surgery. Methods Thirty-three patients with acromegaly caused by pituitary adenoma, admitted to and underwent transnasal transsphenoidal surgery in our hospital from September 2014 to June 2017, were chosen in our study. Clinical data and treatment efficacy of these patients were analyzed retrospectively. The patients were divided into biochemical remission group and non-biochemical remission group according to serum growth hormone (GH) trough value and insulin-like growth factor-1 (IGF-1) levels after oral glucose tolerance test (OGTT) 3 months after surgery, and endocrinology test results of the two groups were compared. Results Thirty-three acromegaly patients underwent microscopic transnasal pituitary surgery. For these patients, 24 achieved total resection, two achieved subtotal resection, 5 achieved massive resection, and two achieved partial resection. Patients were followed up for an average of 13.2 (3-36) months. At 3 months after surgery, blood sugar of two patients with diabetes were restored to normal level; reduction or restoration of hypertension was observed in most patients with preoperative hypertension (81.8%, 9/11); improvement of cardiac hypertrophy or cardiac enlargement was observed in about 1/3 patients with preoperative cardiac organic changes; heart enlargement was improved in 4 patients; one patient had normal sinus arrhythmia. The average interventricular septum thickness of the patients after surgery was significantly reduced as compared with that before surgery ([8.36±1.56] mm vs. [9.22±1.24] mm, P<0.05). The early biochemical remission was achieved in 19 patients (57.6%); as compared with the 14 patients failed to achieve early biochemical remission, those patients achieved early biochemical remission had significantly smaller adenoma diameters and volumes, lower percentages of patients with degrees of adenoma packaging internal carotid artery<135° and Knosp grading 0-2, and higher extent of surgical resection, lower IGF-1 level at one week and three months after surgery, lower GH level one, two and three d, one week and three months after surgery, and lower GH trough value after OGTT before surgery, one week and 3 months after surgery, with significant differences (P<0.05). Conclusions Transsphenoidal surgery is effective treatment for acromegaly caused by pituitary adenoma. Most patients could achieve biochemical remission three months after surgery. And the surgery could help in improving the cardiovascular complications of patients. The patients who are able to achieve early biochemical remission may have the features of smaller adenoma, lower GH trough value after OGTT before and one week after surgery, and lower GH and IGF-1 levels after surgery. Key words: Acromegaly; Pituitary adenoma; Surgery; Growth hormone; Insulin-like growth factor-1