This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Abosch, A. Articles by Wilson, C. B. Search for Related Content PubMed PubMed Citation Articles by Abosch, A. Articles by Wilson, C. B.

Transsphenoidal Microsurgery for Growth Hormone-Secreting Pituitary Adenomas: Initial Outcome and Long-Term Results

Departments of Neurological Surgery (A.A., K.R.L., L.T.H., C.B.A., C.B.W.) and Medicine (J.B.T.), School of Medicine University of California, San Francisco, San Francisco, California 94143-0112

Address all correspondence and requests for reprints to: Aviva Abosch, Department of Neurological Surgery, University of California, San Francisco, 779 Moffitt Hospital, 505 Parnassus Avenue, San Francisco, California 94143-0112.

Treatment of acromegaly has long been recognized as necessary to relieve symptoms, halt progression of deformities, and decompress the sella turcica. More recently, treatment strategies have focused on decreasing GH levels to a point at which mortality rates normalize, thereby redefining previous concepts of a cure. No surgical series to date has investigated the long-term effect of treatment on mortality rates. We retrospectively reviewed 254 consecutive patients with acromegaly who underwent transsphenoidal microsurgery of GH-secreting adenomas between 1974–1992. Seventy-six percent of these patients had basal GH levels <5 ng/mL within 30 days of surgery, and 24% had persistent disease. Multivariate analysis revealed that higher stage, grade, and preoperative GH levels were all predictive of persistence (P < 0.01). Long-term follow-up was obtained on 129 of the patients in initial remission. Of these, 9 (7%) had disease recurrence and 120 remained in remission. The incidence of major postoperative complications was 8% (2% permanent diabetes insipidus, 2% cerebrospinal fluid leaks requiring surgery, 2% meningitis, and 2% hypopituitarism), with no mortality. In contrast to the 2.4- to 4.8-fold increased mortality among untreated acromegalics, the mortality rate among patients with posttherapy GH levels <5 ng/mL was equivalent to that of age- and sex-matched controls. Aggressive therapy to normalize GH levels should therefore be instituted at diagnosis.

This article has been cited by other articles:

				S Petersenn, M Buchfelder, M Reincke, C M Strasburger, H Franz, R Lohmann, H-J Quabbe, U Plockinger, and the Participants of the German Acromegaly Register Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register Eur. J. Endocrinol., November 1, 2008; 159(5): 525 - 532. [Abstract] [Full Text] [PDF]

				I M Holdaway, M J Bolland, and G D Gamble A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly Eur. J. Endocrinol., August 1, 2008; 159(2): 89 - 95. [Abstract] [Full Text] [PDF]

				R. Vazquez-Martinez, A. J. Martinez-Fuentes, M. R. Pulido, L. Jimenez-Reina, A. Quintero, A. Leal-Cerro, A. Soto, S. M. Webb, N. Sucunza, F. Bartumeus, et al. Rab18 Is Reduced in Pituitary Tumors Causing Acromegaly and Its Overexpression Reverts Growth Hormone Hypersecretion J. Clin. Endocrinol. Metab., June 1, 2008; 93(6): 2269 - 2276. [Abstract] [Full Text] [PDF]

				O. Alexopoulou, M. Bex, R. Abs, G. T'Sjoen, B. Velkeniers, and D. Maiter Divergence between Growth Hormone and Insulin-Like Growth Factor-I Concentrations in the Follow-Up of Acromegaly J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1324 - 1330. [Abstract] [Full Text] [PDF]

				O. M. Dekkers, N. R. Biermasz, A. M. Pereira, J. A. Romijn, and J. P. Vandenbroucke Mortality in Acromegaly: A Metaanalysis J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 61 - 67. [Abstract] [Full Text] [PDF]

				L. Sze, C. Schmid, K. E Bloch, R. Bernays, and M. Brandle Effect of transsphenoidal surgery on sleep apnoea in acromegaly Eur. J. Endocrinol., March 1, 2007; 156(3): 321 - 329. [Abstract] [Full Text] [PDF]

				S.-C. Hua, Y.-H. Yan, and T.-C. Chang Associations of remission status and lanreotide treatment with quality of life in patients with treated acromegaly Eur. J. Endocrinol., December 1, 2006; 155(6): 831 - 837. [Abstract] [Full Text] [PDF]

				S Pekic, M Doknic, D Miljic, M Joksimovic, J Glodic, M Djurovic, C Dieguez, F Casanueva, and V Popovic Ghrelin test for the assessment of GH status in successfully treated patients with acromegaly. Eur. J. Endocrinol., May 1, 2006; 154(5): 659 - 666. [Abstract] [Full Text] [PDF]

				A. Colao, R. Pivonello, R. S Auriemma, M. C. De Martino, M. Bidlingmaier, F. Briganti, F. Tortora, P. Burman, I. A Kourides, C. J Strasburger, et al. Efficacy of 12-month treatment with the GH receptor antagonist pegvisomant in patients with acromegaly resistant to long-term, high-dose somatostatin analog treatment: effect on IGF-I levels, tumor mass, hypertension and glucose tolerance. Eur. J. Endocrinol., March 1, 2006; 154(3): 467 - 477. [Abstract] [Full Text] [PDF]

				S. Bhayana, G. L. Booth, S. L. Asa, K. Kovacs, and S. Ezzat The Implication of Somatotroph Adenoma Phenotype to Somatostatin Analog Responsiveness in Acromegaly J. Clin. Endocrinol. Metab., November 1, 2005; 90(11): 6290 - 6295. [Abstract] [Full Text] [PDF]

				G M Besser, P Burman, and A F Daly Predictors and rates of treatment-resistant tumor growth in acromegaly Eur. J. Endocrinol., August 1, 2005; 153(2): 187 - 193. [Abstract] [Full Text] [PDF]

				F. Castinetti, D. Taieb, J.-M. Kuhn, P. Chanson, M. Tamura, P. Jaquet, B. Conte-Devolx, J. Regis, H. Dufour, and T. Brue Outcome of Gamma Knife Radiosurgery in 82 Patients with Acromegaly: Correlation with Initial Hypersecretion J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4483 - 4488. [Abstract] [Full Text] [PDF]

				R. Kauppinen-Makelin, T. Sane, A. Reunanen, M. J. Valimaki, L. Niskanen, H. Markkanen, E. Loyttyniemi, T. Ebeling, P. Jaatinen, H. Laine, et al. A Nationwide Survey of Mortality in Acromegaly J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 4081 - 4086. [Abstract] [Full Text] [PDF]

				D. Selvarajah, J. Webster, R. Ross, and J. Newell-Price Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly Eur. J. Endocrinol., April 1, 2005; 152(4): 569 - 574. [Abstract] [Full Text] [PDF]

				J. J. Puder, S. Nilavar, K. D. Post, and P. U. Freda Relationship between Disease-Related Morbidity and Biochemical Markers of Activity in Patients with Acromegaly J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 1972 - 1978. [Abstract] [Full Text] [PDF]

				P. Nomikos, M. Buchfelder, and R. Fahlbusch The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure' Eur. J. Endocrinol., March 1, 2005; 152(3): 379 - 387. [Abstract] [Full Text] [PDF]

				I. E Bonapart, R. van Domburg, S. M T H ten Have, W. W de Herder, R. A M Erdman, J. A M J L Janssen, and A. J. van der Lely The 'bio-assay' quality of life might be a better marker of disease activity in acromegalic patients than serum total IGF-I concentrations Eur. J. Endocrinol., February 1, 2005; 152(2): 217 - 224. [Abstract] [Full Text] [PDF]

				G. D. Hammer, J. B. Tyrrell, K. R. Lamborn, C. B. Applebury, E. T. Hannegan, S. Bell, R. Rahl, A. Lu, and C. B. Wilson Transsphenoidal Microsurgery for Cushing's Disease: Initial Outcome and Long-Term Results J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6348 - 6357. [Abstract] [Full Text] [PDF]

				D. R. Clemmons and C. Strasburger Monitoring the Response to Treatment in Acromegaly J. Clin. Endocrinol. Metab., November 1, 2004; 89(11): 5289 - 5291. [Full Text] [PDF]

				N. R. Biermasz, F. W. Dekker, A. M. Pereira, S. W. van Thiel, P. J. Schutte, H. van Dulken, J. A. Romijn, and F. Roelfsema Determinants of Survival in Treated Acromegaly in a Single Center: Predictive Value of Serial Insulin-Like Growth Factor I Measurements J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 2789 - 2796. [Abstract] [Full Text] [PDF]

				C. Schmid, P. Wiesli, R. Bernays, K. Bloch, J. Zapf, C. Zwimpfer, C. Ghirlanda, and M. Brandle Decrease in sE-Selectin after Pituitary Surgery in Patients with Acromegaly Clin. Chem., March 1, 2004; 50(3): 650 - 652. [Full Text] [PDF]

				A. Colao, D. Ferone, P. Marzullo, and G. Lombardi Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management Endocr. Rev., February 1, 2004; 25(1): 102 - 152. [Abstract] [Full Text] [PDF]

				P. U. Freda, A. T. Nuruzzaman, C. M. Reyes, R. E. Sundeen, and K. D. Post Significance of "Abnormal" Nadir Growth Hormone Levels after Oral Glucose in Postoperative Patients with Acromegaly in Remission with Normal Insulin-Like Growth Factor-I Levels J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 495 - 500. [Abstract] [Full Text] [PDF]

				I. M. Holdaway, R. C. Rajasoorya, and G. D. Gamble Factors Influencing Mortality in Acromegaly J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 667 - 674. [Abstract] [Full Text] [PDF]

				N. R. Biermasz, A. M. Pereira, M. Frolich, J. A. Romijn, J. D. Veldhuis, and F. Roelfsema Octreotide represses secretory-burst mass and nonpulsatile secretion but does not restore event frequency or orderly GH secretion in acromegaly Am J Physiol Endocrinol Metab, January 1, 2004; 286(1): E25 - E30. [Abstract] [Full Text]

				F. G. Barker II, A. Klibanski, and B. Swearingen Transsphenoidal Surgery for Pituitary Tumors in the United States, 1996-2000: Mortality, Morbidity, and the Effects of Hospital and Surgeon Volume J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4709 - 4719. [Abstract] [Full Text] [PDF]

				D. R. Clemmons, K. Chihara, P. U. Freda, K. K. Y. Ho, A. Klibanski, S. Melmed, S. M. Shalet, C. J. Strasburger, P. J. Trainer, and M. O. Thorner Optimizing Control of Acromegaly: Integrating a Growth Hormone Receptor Antagonist into the Treatment Algorithm J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4759 - 4767. [Abstract] [Full Text] [PDF]

				Z.'e. Hochberg, K. Pacak, and G. P. Chrousos Endocrine Withdrawal Syndromes Endocr. Rev., August 1, 2003; 24(4): 523 - 538. [Abstract] [Full Text] [PDF]

				P. De, D. A. Rees, N. Davies, R. John, J. Neal, R. G. Mills, J. Vafidis, J. S. Davies, and M. F. Scanlon Transsphenoidal Surgery for Acromegaly in Wales: Results Based on Stringent Criteria of Remission J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3567 - 3572. [Abstract] [Full Text] [PDF]

				J. J. Kopchick, C. Parkinson, E. C. Stevens, and P. J. Trainer Growth Hormone Receptor Antagonists: Discovery, Development, and Use in Patients with Acromegaly Endocr. Rev., October 1, 2002; 23(5): 623 - 646. [Abstract] [Full Text] [PDF]

				S. Melmed, F. F. Casanueva, F. Cavagnini, P. Chanson, L. Frohman, A. Grossman, K. Ho, D. Kleinberg, S. Lamberts, E. Laws, et al. Guidelines for Acromegaly Management J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4054 - 4058. [Full Text] [PDF]

				A. C. F. Costa, A. Rossi, C. E. Martinelli Jr., H. R. Machado, and A. C. Moreira Assessment of Disease Activity in Treated Acromegalic Patients Using a Sensitive GH Assay: Should We Achieve Strict Normal GH Levels for a Biochemical Cure? J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3142 - 3147. [Abstract] [Full Text] [PDF]

				C. Parkinson, W. D. J. Ryder, and P. J. Trainer The Relationship between Serum GH and Serum IGF-I in Acromegaly Is Gender-Specific J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5240 - 5244. [Abstract] [Full Text] [PDF]

				J. Kreutzer, M. L. Vance, M. B. S. Lopes, and E. R. Laws Jr. Surgical Management of GH-Secreting Pituitary Adenomas: An Outcome Study Using Modern Remission Criteria J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4072 - 4077. [Abstract] [Full Text] [PDF]

				S. Melmed CLINICAL PERSPECTIVE: Acromegaly and Cancer: Not a Problem? J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2929 - 2934. [Full Text] [PDF]

				G. A. Kaltsas, A. M. Isidori, D. Florakis, P. J. Trainer, C. Camacho-Hubner, F. Afshar, I. Sabin, J. P. Jenkins, S. L. Chew, J. P. Monson, et al. Predictors of the Outcome of Surgical Treatment in Acromegaly and the Value of the Mean Growth Hormone Day Curve in Assessing Postoperative Disease Activity J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1645 - 1652. [Abstract] [Full Text]

				A. J. van der Lely, A. F. Muller, J. A. Janssen, R. J. Davis, K. A. Zib, J. A. Scarlett, and S. W. Lamberts Control of Tumor Size and Disease Activity during Cotreatment with Octreotide and the Growth Hormone Receptor Antagonist Pegvisomant in an Acromegalic Patient J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 478 - 481. [Abstract] [Full Text]

				N. R. Biermasz, H. van Dulken, and F. Roelfsema Ten-Year Follow-Up Results of Transsphenoidal Microsurgery in Acromegaly J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4596 - 4602. [Abstract] [Full Text]

				G. Barrande, M. Pittino-Lungo, J. Coste, D. Ponvert, X. Bertagna, J. P. Luton, and J. Bertherat Hormonal and Metabolic Effects of Radiotherapy in Acromegaly: Long-Term Results in 128 Patients Followed in a Single Center J. Clin. Endocrinol. Metab., October 1, 2000; 85(10): 3779 - 3785. [Abstract] [Full Text]

				N. R. Biermasz, H. van Dulken, and F. Roelfsema Long-Term Follow-Up Results of Postoperative Radiotherapy in 36 Patients with Acromegaly J. Clin. Endocrinol. Metab., July 1, 2000; 85(7): 2476 - 2482. [Abstract] [Full Text]

				A. Giustina, A. Barkan, F. F. Casanueva, F. Cavagnini, L. Frohman, K. Ho, J. Veldhuis, J. Wass, K. von Werder, and S. Melmed Criteria for Cure of Acromegaly: A Consensus Statement{dagger} J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 526 - 529. [Abstract] [Full Text]

				M. R. DRANGE, N. R. FRAM, V. HERMAN-BONERT, and S. MELMED Pituitary Tumor Registry: A Novel Clinical Resource J. Clin. Endocrinol. Metab., January 1, 2000; 85(1): 168 - 174. [Abstract] [Full Text]

				N.J.L. Gittoes, M.C. Sheppard, A.P. Johnson, and P.M. Stewart Outcome of surgery for acromegaly--the experience of a dedicated pituitary surgeon QJM, December 1, 1999; 92(12): 741 - 745. [Abstract] [Full Text] [PDF]

				N. R. Biermasz, H. van Dulken, and F. Roelfsema Direct Postoperative and Follow-Up Results of Transsphenoidal Surgery in 19 Acromegalic Patients Pretreated with Octreotide Compared to Those in Untreated Matched Controls J. Clin. Endocrinol. Metab., October 1, 1999; 84(10): 3551 - 3555. [Abstract] [Full Text] [PDF]

				R N Clayton, P M Stewart, S M Shalet, and J A H Wass Pituitary surgery for acromegaly BMJ, September 4, 1999; 319(7210): 588 - 589. [Full Text]

				S. Melmed Tight Control of Growth Hormone: An Attainable Outcome for Acromegaly Treatment J. Clin. Endocrinol. Metab., October 1, 1998; 83(10): 3409 - 3410. [Full Text]