Article
Can early oral glucose tolerance test define remission and help to improve the outcome after transsphenoidal surgery in patients with acromegaly?
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Authors
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Yawen Wang
- Vivantes Klinikum Friedrichshain Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | April 21, 2016 |
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Outline
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Background: Acromegaly is associated with increased morbidity and mortality. Surgery as first-line therapy is the only therapeutic option which can achieve immediate GH regression. The detection of postoperative residual disease should be defined early to optimize following management strategies. In this respect there is no reliable tool to predict remission early. We present our results of early postoperative follow-up for GH suppression with oral glucose.
Materials and methods: Patients were sampled for GH and IGF-1 on POD 1 or 2. `Remission´ was defined as GH < 1ng/ml in OGTT. IGF-1 is not expected to be normal and thus not included in our early remission criteria. Early second look surgery was performed within 7 days if `remission´ could not be defined. We also reviewed histopathological findings to determine remained GH secreting adenoma tissues. We then evaluated our total early remission rate.
Results: 38 patients with acromegaly unterwent transsphenoidal surgery between 2007- 2014. 27/38 patients (71%) were found to be in early remission after surgery according to GH level in suppression test with oral glucose on POD 1 or 2. Six patients underwent early second look surgery. Remission could be achieved for 4/6 patients after revision. Tumor suspected tissue could be confirmed as GH secreting adenoma on immunohistochemical investigation in 3/6 cases. In total, early biochemical control could be achieved in 31/38 cases when taking revision surgery into account (82%). Patients who could not be defined as `cured´ on POD 1 or 2 were not in remission in long term postoperative follow-up either.
Conclusion: Early detection of persistent GH excess after surgery is essential to benefit management strategies such as early revision surgery which contributes to a higher remission rate. Performing glucose tolerance test on POD 1 or 2 can be helpful to identify persistent residual disease. In our series we could achieve an early remission rate of 81% with the concept of revision on demand. In this respect further investigation addressing early identification of residual disease is required.
