Abstract
PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.
Highlights
Is a disease of excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels, with GH-secreting pituitary adenomas causing 98% of cases (1, 2)
We identified preoperative IGF-1 and postoperative day 1 (POD1) GH levels as predictors of postoperative remission in a series restricted to endoscopic approaches; our statistical power was limited by sample size (16)
The patient who did not present with typical signs or symptoms of acromegaly was 13 years old when the pituitary adenoma was discovered on CT scan as part of sinusitis workup, but he had always been above the 90th percentile for height
Summary
Is a disease of excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels, with GH-secreting pituitary adenomas causing 98% of cases (1, 2). Current literature suggests various predictors including patient sex, preoperative pituitary deficit, tumor size, invasion characteristics, as well as endocrine lab values (3, 6, 8–12). Some studies have suggested postoperative GH levels and decreases in IGF-1 from pre- to postoperative levels as predictors of long-term remission (11, 13–15). We identified preoperative IGF-1 and postoperative day 1 (POD1) GH levels as predictors of postoperative remission in a series restricted to endoscopic approaches; our statistical power was limited by sample size (16). In this study we analyze a series of 94 patients with acromegaly who underwent surgical resection of pituitary adenomas between June 1999 and December 2019 in order to better understand the predictive value of POD1 GH and IGF1 levels
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