Biochemical remission of acromegalic patients who underwent endoscopic surgery

Abstract

Objective. Endoscopic transnasal transsphenoidal surgery is the cornerstone of therapy for acromegaly at our Center. We conducted a retrospective study to determine whether this approach induced biochemical remission, and compared our observations to published series. Methods. We performed a retrospective analysis of our Pituitary Surgery database, and identified all patients that underwent endoscopic transnasal transsphenoidal surgery as primary treatment for acromegaly. Pre- operatory imaging and endocrinological panels were assessed, and the 2009 Acromegaly Consensus Group criteria were used to determine whether biochemical remission was achieved. Results. Eight patients underwent primary endoscopic adenomectomy. One had a microadenoma, one had a non-invasive macroadenoma, and the remaining six patients presented invasive macroadenomas. Median insulin-like growth factor I levels at three months of surgery were 633 ng/mL (199 ng/mL - 1600 ng/mL), while growth hormone levels were 10,20 ng/mL (0,96 ng/mL mL–16,60 ng/mL). Two patients met criteria for remission, with a non-invasive macroadenoma and a microadenoma.Four of the remaining patients achieved remission after administration of somatostatin analogues Conclusions. This is the first report of endoscopic transnasal transsphenoidal surgery as primary treatment for acromegaly in Costa Rica. Attaining cure in patients with large, invasive macroadenomas can be elusive, and a multi-modal approach is necessary.