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Neuroendocrine Clinical Center (B.S., L.K., B.M.K.B., S.G., A.K., N.T.Z.), Neurosurgical Service, Departments of Surgery (B.S., F.G.B., N.M., P.McL.B., N.T.Z.), and Medicine (L.K., B.M.K.B., S.G., A.K.), Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02114
Address all correspondence and requests for reprints to: Brooke Swearingen, M.D., ACC 331, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.
To analyze the long term outcome after multimodality therapy for acromegaly, a retrospective review was performed on 162 patients who underwent transsphenoidal surgery at Massachusetts General Hospital between 1978 and 1996. The surgical cure rate for microadenomas was 91%, that for macroadenomas was 48%, and it was 57% overall. The surgical cure rate was significantly dependent on tumor size, but was not dependent on age or sex. An improvement in the surgical cure rate was noted over the course of the review, from 45% before 1987 to 73% since 1991. Long term follow-up was obtained in 99% of U.S. residents (149 of 151), with a mean follow-up period of 7.8 yr. Adjuvant radiation and/or pharmacological therapy was given to 61 patients. Of the entire group, 83% (124 of 149) were in biochemical remission as determined by normalization of serum insulin-like growth factor I levels or by GH suppression after oral glucose tolerance testing at last contact or at death. The recurrence rate was 6% at 10 yr and 10% at 15 yr after surgery in those patients who initially met the criteria for surgical cure. The 10-yr survival rate was 88%, and there were 12 deaths at postoperative intervals of 212 yr, with the most common cause of death being cardiovascular disease. A Cox proportional hazards model showed that patient-years with persistent disease carried a 3.5-fold [95% confidence interval (CI), 1.012; P = 0.02] relative mortality risk compared to those patient-years in remission. A Poisson person-years regression analysis showed no significant difference in survival between those 86 patients cured at operation and an age- and sex-matched sample from the U.S. population [standardized mortality ratio (SMR), 0.84; 95% CI, 0.32.2; P = 0.35]. A similar analysis on the entire group of 149 patients showed no significant difference in survival from that in a control sample (SMR, 1.16; 95% CI, 0.662.0; P = 0.3). Mortality risk for patient-years with persistent active disease after unsuccessful treatment vs. that in the U.S. population sample remained increased (SMR, 1.8; 95% CI, 0.93.6; P = .05). This analysis suggests that the decreased survival previously reported to be associated with acromegaly can be normalized by successful surgical and adjunctive therapy.
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O. Serri, C. Beauregard, and J. Hardy Long-Term Biochemical Status and Disease-Related Morbidity in 53 Postoperative Patients with Acromegaly J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 658 - 661. [Abstract] [Full Text] [PDF] |
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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] |
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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] |
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J. S. Bevan, S. L. Atkin, A. B. Atkinson, P.-M. Bouloux, F. Hanna, P. E. Harris, R. A. James, M. McConnell, G. A. Roberts, M. F. Scanlon, et al. Primary Medical Therapy for Acromegaly: An Open, Prospective, Multicenter Study of the Effects of Subcutaneous and Intramuscular Slow-Release Octreotide on Growth Hormone, Insulin-Like Growth Factor-I, and Tumor Size J. Clin. Endocrinol. Metab., October 1, 2002; 87(10): 4554 - 4563. [Abstract] [Full Text] [PDF] |
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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] |
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J. Ayuk, S. E. Stewart, P. M. Stewart, and M. C. Sheppard Long-Term Safety and Efficacy of Depot Long-Acting Somatostatin Analogs for the Treatment of Acromegaly J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4142 - 4146. [Abstract] [Full Text] [PDF] |
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P. J. Trainer Acromegaly--Consensus, What Consensus? J. Clin. Endocrinol. Metab., August 1, 2002; 87(8): 3534 - 3536. [Full Text] [PDF] |
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E. V. Dimaraki, C. A. Jaffe, R. DeMott-Friberg, W. F. Chandler, and A. L. Barkan Acromegaly with Apparently Normal GH Secretion: Implications for Diagnosis and Follow-Up J. Clin. Endocrinol. Metab., August 1, 2002; 87(8): 3537 - 3542. [Abstract] [Full Text] [PDF] |
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P. U. Freda Somatostatin Analogs in Acromegaly J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3013 - 3018. [Full Text] [PDF] |
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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] |
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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] |
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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] |
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S. Melmed CLINICAL PERSPECTIVE: Acromegaly and Cancer: Not a Problem? J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2929 - 2934. [Full Text] [PDF] |
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D. C. Danila, J. N. S. Haidar, X. Zhang, L. Katznelson, M. D. Culler, and A. Klibanski Somatostatin Receptor-Specific Analogs: Effects on Cell Proliferation and Growth Hormone Secretion in Human Somatotroph Tumors J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2976 - 2981. [Abstract] [Full Text] [PDF] |
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A. Colao, A. Cuocolo, P. Marzullo, E. Nicolai, D. Ferone, A. M. Della Morte, R. Pivonello, M. Salvatore, and G. Lombardi Is the Acromegalic Cardiomyopathy Reversible? Effect of 5-Year Normalization of Growth Hormone and Insulin-Like Growth Factor I Levels on Cardiac Performance J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1551 - 1557. [Abstract] [Full Text] |
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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] |
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S. R. Peacey, A. A. Toogood, J. D. Veldhuis, M. O. Thorner, and S. M. Shalet The Relationship between 24-Hour Growth Hormone Secretion and Insulin-Like Growth Factor I in Patients with Successfully Treated Acromegaly: Impact of Surgery or Radiotherapy J. Clin. Endocrinol. Metab., January 1, 2001; 86(1): 259 - 266. [Abstract] [Full Text] |
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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] |
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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] |
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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] |
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J. S. Powell, S. L. Wardlaw, K. D. Post, and P. U. Freda Outcome of Radiotherapy for Acromegaly Using Normalization of Insulin-Like Growth Factor I to Define Cure J. Clin. Endocrinol. Metab., May 1, 2000; 85(5): 2068 - 2071. [Abstract] [Full Text] |
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P. J. Trainer, W. M. Drake, L. Katznelson, P. U. Freda, V. Herman-Bonert, A.J. van der Lely, E. V. Dimaraki, P. M. Stewart, K. E. Friend, M. L. Vance, et al. Treatment of Acromegaly with the Growth Hormone-Receptor Antagonist Pegvisomant N. Engl. J. Med., April 20, 2000; 342(16): 1171 - 1177. [Abstract] [Full Text] [PDF] |
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R. D. Utiger Treatment of Acromegaly N. Engl. J. Med., April 20, 2000; 342(16): 1210 - 1211. [Full Text] |
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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] |
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H.E. Turner and J.A.H. Wass Modern approaches to treating acromegaly QJM, January 1, 2000; 93(1): 1 - 6. [Full Text] [PDF] |
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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] |
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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] |
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P. U. Freda and S. L. Wardlaw Diagnosis and Treatment of Pituitary Tumors J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 3859 - 3866. [Full Text] |
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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] |
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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] |
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