Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience

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• 作者：Ozlem Haliloglu¹ ; Enis Kuruoglu² ; Hande Mefkure Ozkaya¹ ; Fatma Ela Keskin¹ ; Omur Gunaldi² ; Buge Oz³ ; Nurperi Gazioglu² ; Pinar Kadioglu¹ ; Necmettin Tanriover² ; ^{nctan27@yahoo.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Acromegaly ; Early remission ; Late remission ; Proliferation indices
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：88
• 期：Complete
• 页码：270-276
• 全文大小：2322 K

文摘

Acromegaly is a multisystemic disease that requires a multidisciplinary approach. The aim of this study was to determine early and late remissions of patients who underwent surgery at our center and to evaluate relations between pathologic and radiologic properties of adenoma and medical and radiosurgical treatments with remissions.

Methods

The medical records of 103 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery in Cerrahpasa Medical Faculty, Istanbul University, between 2007 and 2014 were reviewed. Clinical, biochemical, radiologic, and pathologic properties were determined.

Results

The total median follow-up time was 38 months [interquartile range: 24–53.5 months]. Thirty-two percent of the adenomas were microadenomas and 68% were macroadenomas The early remission rate was 51.5% and late remission was 75.2%. The sellar floor invasion was significantly lower in patients with early and late remissions (P = 0.01 and P = 0.009, respectively). The initial growth hormone (GH; P < 0.001), first-day GH (P = 0.03), 3-month GH (P = 0.001), insulin-like growth factor-1 (P = 0.004), and 6-month insulin-like growth factor-1 (P = 0.02) levels were significantly greater in patients with sellar floor invasion. The late remission rates (P = 0.004) were greter and reoperation needs (P = 0.05) were lower in patients with Ki-67 <3% than in patients with ≥3%. Seventy (68.6%) patients needed medical therapy during follow-up.

Conclusions

Late remission was achieved using a multidiciplinary approach in 75.2% of 103 patients with acromegaly, and young age, male sex, high Ki-67 and mitosis indices, and cavernous sinus and sellar-floor invasion had negative effects on clinical and biochemical control of the disease.