gms | German Medical Science

Objective: The objective of the study was to identify the rates of surgical remission determining the status of growth hormone (GH) and serum insulin-like growth factor-1 (IGF-1) of acromegaly patients. Furthermore, the long-term outcome of 4 identified subgroups of patients was evaluated, according growth and invasion of adenoma as well as preoperative and postoperative medication.

Methods: Single-center, retrospective study of the long-term outcome of acromegaly patients according to the biochemical cure-criteria of the Acromegaly Consensus Group 2010. Also, analysis of the outcome according to the pre- and postoperative medication, the growth of the adenoma and the grade of invasion. Data on long-term follow-up were recorded from 1984 until 2013.

Results: We included 156 patients. All of them received a transsphenoidal transnasal microsurgical resection of pituitary adenoma in our neurosurgical centre. Remission for GH and IGF-1 was achieved in 73.7%. GH only showed remission in 4.5% and IGF-1 only in 12.2%. 9.6% of the patients showed no remission for neither GH or IGF. In addition 77.4% of microadenomas and 73.6% of macroadenomas were postoperatively biochemically controlled. Concerning invasiveness 71.1% of the invasive and 78.5% of the non-invasive adenomas showed remission for both cure-criteria. In terms of medication 61.7% of the patients in remission for GH and IGF-1 took a medication preoperative (90.1% of them took octreotide). In contrast complete remission was found in 38.2% of patients without preoperative medication.

Conclusion: We identified not only two groups of patients, controlled and non-controlled according to the biochemical cure-criteria, but two additional intermediate groups. It is not clear yet, how these 2 subgroups (only GH controlled and only IGF-1 controlled) should be treated.