Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients

被引:44
作者
Albarel, Frederique [1 ,2 ]
Castinetti, Frederic [1 ,2 ]
Morange, Isabelle [1 ,2 ]
Conte-Devolx, Bernard [1 ,2 ]
Gaudart, Jean [3 ]
Dufour, Henry
Brue, Thierry [1 ,2 ,4 ]
机构
[1] Aix Marseille Univ, CNRS, CRN2M, UMR 7286, F-13344 Marseille 15, France
[2] Hop La Timone, APHM, Serv Endocrinol Diabet & Malad Metab, Ctr Reference Malad Rares Origine Hypophysaire DE, F-13385 Marseille 15, France
[3] Aix Marseille Univ, SESSTIM UMR912, AP HM, UF 6671 Biostat, F-13385 Marseille 15, France
[4] Aix Marseille Univ, Timone Hosp, Dept Endocrinol, APHM,Serv Neurochirurg, F-13385 Marseille 05, France
关键词
SECRETING PITUITARY-ADENOMAS; ENDOCRINOLOGIC FOLLOW-UP; TRANSSPHENOIDAL SURGERY; GROWTH-HORMONE; CONSENSUS STATEMENT; MORTALITY; CRITERIA; GH; PREDICTORS; MANAGEMENT;
D O I
10.1111/j.1365-2265.2012.04492.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction Given the new therapeutic options in acromegaly, it seemed important to evaluate the outcome of operated acromegalic patients today. Objective To analyse the characteristics and short- and long-term surgical outcome of patients who underwent transsphenoidal surgery for a growth hormone (GH)-secreting adenoma in our centre and to determine predictive factors of remission. Design and patients This retrospective 10-year study included 115 newly diagnosed acromegalic patients operated on at Timone University Hospital, Marseille, France, between 1997 and 2007. Measurements Initial and long-term outcomes were evaluated using stringent and current remission criteria, associating GH nadir after oral glucose tolerance test <0.4 mu g/l and normal insulin-like growth factor-1 (IGF-1) at 3 months, and a normal IGF-1 at the end of follow-up (52.4 +/- 36.8 months, median 41 months, range 6.7135.4 months, n = 99). Results At the end of follow-up, 90.9% of patients had controlled disease. Overall, 49.5% of patients were in long-term remission after surgery alone, and only 2.0% of patients experienced recurrent disease. Multivariate predictors of 3-month remission included mean GH at diagnosis (P = 0.033), tumour invasion (P = 0.013) and surgeon report of incomplete or uncertain macroscopic resection (P = 0.003 and P = 0.047, respectively). Multivariate predictors at diagnosis of long-term remission included mean GH level (P = 0.048), adenoma size (P = 0.007) and absence of pituitary deficit (P = 0.026). Conclusions In long-term follow-up after surgery of acromegaly, half of the patients achieved remission after surgery alone and more than 90% had their disease controlled. With stringent 3-month remission criteria, recurrence was rare.
引用
收藏
页码:263 / 270
页数:8
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