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Hormones

, Volume 13, Issue 1, pp 95–103 | Cite as

Diagnostic features and outcome of surgical therapy of acromegalic patients: Experience of the last three decades

  • Elisa Sala
  • Emanuele Ferrante
  • Marco Locatelli
  • Paolo Rampini
  • Giovanna Mantovani
  • Claudia Giavoli
  • Marcello Filopanti
  • Elisa Verrua
  • Elena Malchiodi
  • Giorgio Carrabba
  • Maura Arosio
  • Paolo Beck-Peccoz
  • Anna Spada
  • Andrea Gerardo Lania
Research paper

Abstract

OBJECTIVE

Transsphenoidal (TNS) surgery remains the primary therapeutic option for GH-secreting pituitary adenomas. The aims of this study were to verify the impact of TNS surgery on treatment of acromegaly before and after identification by a dedicated neurosurgical team and to enumerate diagnostic features of the disease described over three decades.

DESIGN

41 patients (group A) who underwent TNS surgery by a dedicated neurosurgical team (2000–2008) and 126 patients (group B) operated on by surgeons not specialized in pituitary surgery (1979–1999) were retrospectively analyzed.

RESULTS

No significant differences were observed between the two groups in terms of delay of diagnosis, mean basal GH levels and GH nadir values, prevalence of hypopituitarism and hypertension. IGF-I SDS were significantly higher, while prevalence of IGT/diabetes was significantly lower in group B than in group A. Overall remission rate after surgery was 58.5% for group A (75% in microadenomas and 48% in macroadenomas, P=NS) and 37% for group B (P<0.05 vs group A; for microadenomas, 34% vs 75% of group A, P<0.05, for macroadenomas, 36% vs 48% of group A, P=Ns). The mean delay of diagnosis was 4.9 and 5.9 years in group A and B, respectively.

CONCLUSIONS

Our data confirm that a dedicated neurosurgical team is needed in order to improve remission rates in acromegalic patients. No changes in biochemical, clinical and neuroradiological presentation of disease were observed over the last three decades. As the high prevalence of macroadenomas negatively influences surgical cure, earlier diagnosis should be considered as mandatory to achieve a better outcome.

Key words

Acromegaly Microscopic approach Transsphenoidal (TNS) surgery 

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Copyright information

© Hellenic Endocrine Society 2014

Authors and Affiliations

  • Elisa Sala
    • 1
    • 2
  • Emanuele Ferrante
    • 1
    • 2
  • Marco Locatelli
    • 3
  • Paolo Rampini
    • 3
  • Giovanna Mantovani
    • 1
    • 2
  • Claudia Giavoli
    • 1
    • 2
  • Marcello Filopanti
    • 1
    • 2
  • Elisa Verrua
    • 1
    • 2
  • Elena Malchiodi
    • 1
    • 2
  • Giorgio Carrabba
    • 3
  • Maura Arosio
    • 1
    • 4
  • Paolo Beck-Peccoz
    • 1
    • 2
  • Anna Spada
    • 1
    • 2
  • Andrea Gerardo Lania
    • 5
  1. 1.Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
  2. 2.Endocrinology and Diabetology Unit - Pad. GranelliFondazione IRCCS Cà Granda-Ospedale Maggiore PoliclinicoMilanItaly
  3. 3.Unit of NeurosurgeryFondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoMilanItaly
  4. 4.Unit of Endocrine Diseases and DiabetologySan Giuseppe Hospital, Multimedica GroupMilanItaly
  5. 5.BIOMETRA DepartmentUniversity of Milan, IRCCS Istituto Clinico HumanitasRozzanoItaly

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