Artikel
Predictive value of tumor size and cavernous sinus invasion for the outcome of transsphenoidal surgery in acromegaly
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Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: Acromegaly is associated with increased morbidity and mortality unless serum growth hormone (GH) levels are persistently normalized after treatment. Insulin-like growth factor (IGF-1) is a sensitive measure of integrated GH production and closely correlates with disease activity. The transsphenoidal surgical resection remains the best therapeutical option for a stable endocrinological remission. Early normalization of IGF-I is associated with persistent cure. In long-term follow-up approximately 40% of patients undergoing surgical resection show a normalization of IGF-1 without further radiotherapy or medical treatment. Our aim was to correlate tumor size and cavernous sinus invasion to disease control measured by IGF-1 normalization in postoperative follow-up.
Method: Preoperative MRI of 104 consecutive patients with newly diagnosed acromegaly who were surgically treated between 2005 and 2012 were assessed. Mean tumor diameter was calculated from the 3 diameters (anterior-posterior, right-left, superior-inferior). Cavernous sinus invasion was evaluated applying the Knosp Grades 1–4. The criterion for remission was normalization of sex- and age-adjusted insulin-like growth factor 1 (IGF 1) value 3-6 months after surgery. None of the patients was under medical treatment at the time of assessment.
Results: Overall, endocrinological remission with normal IGF-1 was attained in 64.4% of the patients. 19% of the adenomas were in the microadenoma stage (<10 mm). The majority of adenomas (58%) had a mean diameter of 2–3 cm. Normalization was IGF-1 was found in 95% of microadenomas, in 65% of macroadenomas with a diameter of 1–2 cm, in 45% of macroadenomas with a diameter of 2–3 cm and in none of the adenomas greater than 3 cm. Normalization of IGF-1 was achieved in 79% of non-invasive adenomas (Knosp grade 1+2). Remission was achieved in 63% of patients with questionable cavernous sinus invasion (Knosp 3) and in only 36% of the patients with obvious invasion (Knops 4+5).
Conclusions: Tumor size and cavernous sinus invasion are highly predictive for endocrinological remission in pituitary surgery. Disease control could be attained in most of the non-invasive microadenomas. In macroadenomas > 3cm normalization of IGF-1 could not be achieved.