Prognostication of Surgery Results in Cases with Acromegaly

Grigorev ., Azizyan V.

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

Acromegaly is a disease, conditioned by hyperproduction of somatotropic hormone (STH). Its main cause is pituitary adenomas. Surgical treatment is considered to be a method of the first priority.

Material and Methods. There were 47 cases, operated in the Endocrinic Center of the Russian Academy of Medical Science in 1997-2005. Tumor removal was primary. It was performed with applying a transsphenoidal approach. Remission criteria were as follows: a basal STH of less than 5mU/l (<2 mcg/l), watched a year after operation; a STH level of less than 2mU/l (<1mcg/l), revealed by an oral glucose-tolerance test; normal indices of insulin-like growth factor-I (IGF-I).

Results. Clinical-hormonal remission was complete in 29 cases (61.7%), subject to adenomectomy a year before (the A group). Incomplete remission and its absence were watched in 3 (6.4%; the B group) and 15 (31.9%; the C group) of patients respectively. Besides, the A group included cases with no expected reduction of STH and IGF-I in an early postoperative period, but normal basal STH levels; complete clinical-endocrinic remission developed in all of them (52.6%) a year after operation. As for the B group, a state improved in 15.8% of cases; they had normal levels of basal STH. There were no disease remission and reduction of basal STH soon after operation in 31.9% of patients (the C group).

Conclusion. Cases with normal basal STH, but no desirable and expected reduction of its level in an early postoperative period, demand control for timely carrying out treatment of the second priority. Early prescription of drugs with subsequent decision on tactics of treatment, made 6 months later, is indicated in patients with an increased level of basal STH, watched 5-7 days after operation (the C group).