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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Endoscopic transsphenoidal surgery for acromegaly: Remission using modern criteria, complications, and predictors of outcome
Journal of Clinical Endocrinology and Metabolism, Volume 96, No. 9, Year 2011
Notification
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Description
Context: Despite the growing application of endoscopic transsphenoidal surgery (ETSS), outcomes for GH adenomas are not clearly defined. Objective:Wereviewed our experience with ETSS with specific interest in remission rates using the 2010 consensus criteria, predictors of remission, and associated complications. Design and Setting: This was a retrospective single institution study. Patients, Interventions, and Outcome Measures: Sixty acromegalic patients who underwent ETSS were identified. Remission was defined as a normal IGF-I and either a suppressed GH less than 0.4 ng/ml during an oral glucose tolerance test or a random GH less than 1.0 ng/ml. Results: Remission was achieved in all 14 microadenomas and 28 of 46 macroadenomas (61%). Tumor size, age, gender, and history of prior surgery were not predictive on multivariant analysis. In hospital postoperative morning GH levels less than 2.5 ng/ml provided the best prediction of remission (P < 0.001). Preoperative variables predictive of remission included Knosp score (P =0.017), IGF-I (P = 0.030), and GH (P = 0.042) levels. New endocrinopathy consisted of diabetes insipidus in 5%, adrenal insufficiency in 5.4%, and new hypogonadism in 29% of men and 17% of women. However, 41% of hypogonadal men had normal postoperative testosterone levels and 83% of amenorrheic women regained menses. The most common complaints after surgery were sinonasal (36 of 60, 60%) resolving in all but two. Conclusions: ETSS for GH adenomas is associated with high rates of remission and a low incidence of new endocrinopathy. Despite the panoramic views offered by the endoscope, invasive tumors continue to have lower rates of remission. Copyright © 2011 by The Endocrine Society.
Authors & Co-Authors
Jane, John A.
United States, Charlottesville
University of Virginia Health System
Starke, Robert Michael
United States, Charlottesville
University of Virginia Health System
Elzoghby, Mohamed A.
United States, Charlottesville
University of Virginia Health System
Reames, Davis L.
United States, Charlottesville
University of Virginia Health System
Payne, Spencer C.
United States, Charlottesville
University of Virginia Health System
Thorner, Michael O.
United States, Charlottesville
University of Virginia Health System
Marshall, John C.
United States, Charlottesville
University of Virginia Health System
Laws, Edward Raymond
United States, Boston
Brigham and Women's Hospital
Lee Vance, Mary Lee
United States, Charlottesville
University of Virginia Health System
Egypt, Cairo
Ain Shams University
Statistics
Citations: 267
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.1210/jc.2011-0554
ISSN:
0021972X
e-ISSN:
19457197
Research Areas
Cancer
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study
Participants Gender
Male
Female