Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience
BACKGROUND A number of surgical series have been reported on the treatment of acromegaly and their results vary widely. The acceptable definition of remission has changed in recent years and it is known, though in a small series, that growth hormone levels of > 5 mU/l are still associated with an...
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| Veröffentlicht in: | Clinical endocrinology (Oxford) 1999-05, Vol.50 (5), p.561-567 |
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| creator | Ahmed, S Elsheikh, M Stratton, I M Page, R C Adams, C B Wass, J A |
| description | BACKGROUND
A number of surgical series have been reported on the treatment of acromegaly and their results vary widely. The acceptable definition of remission has changed in recent years and it is known, though in a small series, that growth hormone levels of > 5 mU/l are still associated with an increased mortality from the condition. We have analysed data at this centre and examined the outcome of transphenoidal surgery for acromegaly, compared our results with recently published series from other centres and also assessed factors which might effect outcome including whether there is any demonstrable effect of the experience of the surgeon on outcome.
PATIENTS AND METHODS
We have analysed data from all of our 139 patients in whom follow up data are available who have undergone initial transphenoidal surgery for acromegaly by one surgeon at this centre, between 1974 and 1995. Follow up was for a median of 5 years (range 1 month to 17 years).
RESULTS
67% of patients achieved the criterion for remission (mean GH |
| doi_str_mv | 10.1046/j.1365-2265.1999.00760.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70013159</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70013159</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4950-287424e704113350b597ac1b994ec42ad4e4f541a342321319a256fa8822507d3</originalsourceid><addsrcrecordid>eNqNkM1u1DAURi0EokPhFZDFgl3C9V8cS2zQqFNAVYtQgQ2S5UluWg-ZJLUTMfP2OE1VIVasYinnfLIPIZRBzkAW73Y5E4XKOC9UzowxOYAuID88IavHH0_JCgRABkUhT8iLGHcAoErQz8nJPFIaDivy82oaq36PtG_oGFwXh1vsel-7lsYp3GA40qYP1FUhQTeuPVLX1dSPkQZs3ej7Lt76gY79Pe6r5OFhwOCxq_Aleda4NuKrh-8p-bY5u15_zC6uzj-tP1xklTQKMl5qySVqkIwJoWCrjHYV2xojsZLc1RJloyRzQnLBmWDGcVU0riw5V6BrcUreLrtD6O8mjKPd-1hh27oO-ylaDZAsZRL45h9w10-hS3ezzJS6BKV1gsoFSm-OMWBjh-D3LhwtAzuXszs7V7ZzZTvnt_f57SGprx_2p-0e67_EpXcC3i_Ab9_i8b-H7frsMh2Sni26jyMeHnUXftlCC63sj8tza64_f_n6fQN2I_4AGUOhuA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>198780577</pqid></control><display><type>article</type><title>Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Ahmed, S ; Elsheikh, M ; Stratton, I M ; Page, R C ; Adams, C B ; Wass, J A</creator><creatorcontrib>Ahmed, S ; Elsheikh, M ; Stratton, I M ; Page, R C ; Adams, C B ; Wass, J A</creatorcontrib><description>BACKGROUND
A number of surgical series have been reported on the treatment of acromegaly and their results vary widely. The acceptable definition of remission has changed in recent years and it is known, though in a small series, that growth hormone levels of > 5 mU/l are still associated with an increased mortality from the condition. We have analysed data at this centre and examined the outcome of transphenoidal surgery for acromegaly, compared our results with recently published series from other centres and also assessed factors which might effect outcome including whether there is any demonstrable effect of the experience of the surgeon on outcome.
PATIENTS AND METHODS
We have analysed data from all of our 139 patients in whom follow up data are available who have undergone initial transphenoidal surgery for acromegaly by one surgeon at this centre, between 1974 and 1995. Follow up was for a median of 5 years (range 1 month to 17 years).
RESULTS
67% of patients achieved the criterion for remission (mean GH < 5 mU/l). Success was related to tumour size and preoperative growth hormone values. Thus 91% of patients with microadenomas were in remission postoperatively compared to 46% of patients with macroadenomas. Analysis of the results according to the year of operation showed an improvement in success rates with time. More than 15 years ago, the success rate according to the growth hormone criteria set was 48% and the failure rate 52%. In contrast in the last 5 years analysed, the overall success rate was 74% with a failure rate of 26% (P < 0.04). The success rate for microadenomas was 50% initially, then remained 100%. The case mix was analysed and no change was found. We have also demonstrated an improvement in pituitary function (including normalization of preoperative elevated prolactin) with time so that pre 1981 16% of patients' pituitary function improved peri‐operatively but 10 years later this figure had risen to 34% (P < 0.03). There was no change over time in the development of pituitary hypofunction, complication rate or recurrence rate.
CONCLUSION
Surgical treatment is a safe and effective treatment for acromegaly and remains the first choice of treatment for most acromegalic patients. The results of this centre compare favourably with series from other centres. We have demonstrated improved results, both in terms of post operative growth hormone values and pituitary function tests with time and increasing neurosurgical experience. We conclude that outcome for the surgical treatment for acromegaly is best achieved with one surgeon specialising in pituitary surgery. Improved operative outcome thus achieved has major cost implications and avoids the necessity for consideration of postoperative radiotherapy and the use of expensive growth hormone suppressing drugs in the postoperative period.</description><identifier>ISSN: 0300-0664</identifier><identifier>EISSN: 1365-2265</identifier><identifier>DOI: 10.1046/j.1365-2265.1999.00760.x</identifier><identifier>PMID: 10468920</identifier><language>eng</language><publisher>Oxford BSL: Blackwell Science Ltd</publisher><subject>Acromegaly - blood ; Acromegaly - physiopathology ; Acromegaly - surgery ; Adenoma - blood ; Adenoma - physiopathology ; Adenoma - surgery ; Adolescent ; Adult ; Aged ; Chi-Square Distribution ; Clinical Competence ; Female ; Growth Hormone - blood ; Humans ; Male ; Middle Aged ; Pituitary Gland - physiopathology ; Pituitary Neoplasms - blood ; Pituitary Neoplasms - physiopathology ; Pituitary Neoplasms - surgery ; Treatment Outcome</subject><ispartof>Clinical endocrinology (Oxford), 1999-05, Vol.50 (5), p.561-567</ispartof><rights>Blackwell Science Ltd, Oxford</rights><rights>Copyright Blackwell Scientific Publications Ltd. May 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4950-287424e704113350b597ac1b994ec42ad4e4f541a342321319a256fa8822507d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2265.1999.00760.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2265.1999.00760.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10468920$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahmed, S</creatorcontrib><creatorcontrib>Elsheikh, M</creatorcontrib><creatorcontrib>Stratton, I M</creatorcontrib><creatorcontrib>Page, R C</creatorcontrib><creatorcontrib>Adams, C B</creatorcontrib><creatorcontrib>Wass, J A</creatorcontrib><title>Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience</title><title>Clinical endocrinology (Oxford)</title><addtitle>Clinical Endocrinology</addtitle><description>BACKGROUND
A number of surgical series have been reported on the treatment of acromegaly and their results vary widely. The acceptable definition of remission has changed in recent years and it is known, though in a small series, that growth hormone levels of > 5 mU/l are still associated with an increased mortality from the condition. We have analysed data at this centre and examined the outcome of transphenoidal surgery for acromegaly, compared our results with recently published series from other centres and also assessed factors which might effect outcome including whether there is any demonstrable effect of the experience of the surgeon on outcome.
PATIENTS AND METHODS
We have analysed data from all of our 139 patients in whom follow up data are available who have undergone initial transphenoidal surgery for acromegaly by one surgeon at this centre, between 1974 and 1995. Follow up was for a median of 5 years (range 1 month to 17 years).
RESULTS
67% of patients achieved the criterion for remission (mean GH < 5 mU/l). Success was related to tumour size and preoperative growth hormone values. Thus 91% of patients with microadenomas were in remission postoperatively compared to 46% of patients with macroadenomas. Analysis of the results according to the year of operation showed an improvement in success rates with time. More than 15 years ago, the success rate according to the growth hormone criteria set was 48% and the failure rate 52%. In contrast in the last 5 years analysed, the overall success rate was 74% with a failure rate of 26% (P < 0.04). The success rate for microadenomas was 50% initially, then remained 100%. The case mix was analysed and no change was found. We have also demonstrated an improvement in pituitary function (including normalization of preoperative elevated prolactin) with time so that pre 1981 16% of patients' pituitary function improved peri‐operatively but 10 years later this figure had risen to 34% (P < 0.03). There was no change over time in the development of pituitary hypofunction, complication rate or recurrence rate.
CONCLUSION
Surgical treatment is a safe and effective treatment for acromegaly and remains the first choice of treatment for most acromegalic patients. The results of this centre compare favourably with series from other centres. We have demonstrated improved results, both in terms of post operative growth hormone values and pituitary function tests with time and increasing neurosurgical experience. We conclude that outcome for the surgical treatment for acromegaly is best achieved with one surgeon specialising in pituitary surgery. Improved operative outcome thus achieved has major cost implications and avoids the necessity for consideration of postoperative radiotherapy and the use of expensive growth hormone suppressing drugs in the postoperative period.</description><subject>Acromegaly - blood</subject><subject>Acromegaly - physiopathology</subject><subject>Acromegaly - surgery</subject><subject>Adenoma - blood</subject><subject>Adenoma - physiopathology</subject><subject>Adenoma - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Chi-Square Distribution</subject><subject>Clinical Competence</subject><subject>Female</subject><subject>Growth Hormone - blood</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pituitary Gland - physiopathology</subject><subject>Pituitary Neoplasms - blood</subject><subject>Pituitary Neoplasms - physiopathology</subject><subject>Pituitary Neoplasms - surgery</subject><subject>Treatment Outcome</subject><issn>0300-0664</issn><issn>1365-2265</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkM1u1DAURi0EokPhFZDFgl3C9V8cS2zQqFNAVYtQgQ2S5UluWg-ZJLUTMfP2OE1VIVasYinnfLIPIZRBzkAW73Y5E4XKOC9UzowxOYAuID88IavHH0_JCgRABkUhT8iLGHcAoErQz8nJPFIaDivy82oaq36PtG_oGFwXh1vsel-7lsYp3GA40qYP1FUhQTeuPVLX1dSPkQZs3ej7Lt76gY79Pe6r5OFhwOCxq_Aleda4NuKrh-8p-bY5u15_zC6uzj-tP1xklTQKMl5qySVqkIwJoWCrjHYV2xojsZLc1RJloyRzQnLBmWDGcVU0riw5V6BrcUreLrtD6O8mjKPd-1hh27oO-ylaDZAsZRL45h9w10-hS3ezzJS6BKV1gsoFSm-OMWBjh-D3LhwtAzuXszs7V7ZzZTvnt_f57SGprx_2p-0e67_EpXcC3i_Ab9_i8b-H7frsMh2Sni26jyMeHnUXftlCC63sj8tza64_f_n6fQN2I_4AGUOhuA</recordid><startdate>199905</startdate><enddate>199905</enddate><creator>Ahmed, S</creator><creator>Elsheikh, M</creator><creator>Stratton, I M</creator><creator>Page, R C</creator><creator>Adams, C B</creator><creator>Wass, J A</creator><general>Blackwell Science Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>199905</creationdate><title>Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience</title><author>Ahmed, S ; Elsheikh, M ; Stratton, I M ; Page, R C ; Adams, C B ; Wass, J A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4950-287424e704113350b597ac1b994ec42ad4e4f541a342321319a256fa8822507d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Acromegaly - blood</topic><topic>Acromegaly - physiopathology</topic><topic>Acromegaly - surgery</topic><topic>Adenoma - blood</topic><topic>Adenoma - physiopathology</topic><topic>Adenoma - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Chi-Square Distribution</topic><topic>Clinical Competence</topic><topic>Female</topic><topic>Growth Hormone - blood</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pituitary Gland - physiopathology</topic><topic>Pituitary Neoplasms - blood</topic><topic>Pituitary Neoplasms - physiopathology</topic><topic>Pituitary Neoplasms - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahmed, S</creatorcontrib><creatorcontrib>Elsheikh, M</creatorcontrib><creatorcontrib>Stratton, I M</creatorcontrib><creatorcontrib>Page, R C</creatorcontrib><creatorcontrib>Adams, C B</creatorcontrib><creatorcontrib>Wass, J A</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical endocrinology (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahmed, S</au><au>Elsheikh, M</au><au>Stratton, I M</au><au>Page, R C</au><au>Adams, C B</au><au>Wass, J A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience</atitle><jtitle>Clinical endocrinology (Oxford)</jtitle><addtitle>Clinical Endocrinology</addtitle><date>1999-05</date><risdate>1999</risdate><volume>50</volume><issue>5</issue><spage>561</spage><epage>567</epage><pages>561-567</pages><issn>0300-0664</issn><eissn>1365-2265</eissn><abstract>BACKGROUND
A number of surgical series have been reported on the treatment of acromegaly and their results vary widely. The acceptable definition of remission has changed in recent years and it is known, though in a small series, that growth hormone levels of > 5 mU/l are still associated with an increased mortality from the condition. We have analysed data at this centre and examined the outcome of transphenoidal surgery for acromegaly, compared our results with recently published series from other centres and also assessed factors which might effect outcome including whether there is any demonstrable effect of the experience of the surgeon on outcome.
PATIENTS AND METHODS
We have analysed data from all of our 139 patients in whom follow up data are available who have undergone initial transphenoidal surgery for acromegaly by one surgeon at this centre, between 1974 and 1995. Follow up was for a median of 5 years (range 1 month to 17 years).
RESULTS
67% of patients achieved the criterion for remission (mean GH < 5 mU/l). Success was related to tumour size and preoperative growth hormone values. Thus 91% of patients with microadenomas were in remission postoperatively compared to 46% of patients with macroadenomas. Analysis of the results according to the year of operation showed an improvement in success rates with time. More than 15 years ago, the success rate according to the growth hormone criteria set was 48% and the failure rate 52%. In contrast in the last 5 years analysed, the overall success rate was 74% with a failure rate of 26% (P < 0.04). The success rate for microadenomas was 50% initially, then remained 100%. The case mix was analysed and no change was found. We have also demonstrated an improvement in pituitary function (including normalization of preoperative elevated prolactin) with time so that pre 1981 16% of patients' pituitary function improved peri‐operatively but 10 years later this figure had risen to 34% (P < 0.03). There was no change over time in the development of pituitary hypofunction, complication rate or recurrence rate.
CONCLUSION
Surgical treatment is a safe and effective treatment for acromegaly and remains the first choice of treatment for most acromegalic patients. The results of this centre compare favourably with series from other centres. We have demonstrated improved results, both in terms of post operative growth hormone values and pituitary function tests with time and increasing neurosurgical experience. We conclude that outcome for the surgical treatment for acromegaly is best achieved with one surgeon specialising in pituitary surgery. Improved operative outcome thus achieved has major cost implications and avoids the necessity for consideration of postoperative radiotherapy and the use of expensive growth hormone suppressing drugs in the postoperative period.</abstract><cop>Oxford BSL</cop><pub>Blackwell Science Ltd</pub><pmid>10468920</pmid><doi>10.1046/j.1365-2265.1999.00760.x</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Acromegaly - blood Acromegaly - physiopathology Acromegaly - surgery Adenoma - blood Adenoma - physiopathology Adenoma - surgery Adolescent Adult Aged Chi-Square Distribution Clinical Competence Female Growth Hormone - blood Humans Male Middle Aged Pituitary Gland - physiopathology Pituitary Neoplasms - blood Pituitary Neoplasms - physiopathology Pituitary Neoplasms - surgery Treatment Outcome |
| title | Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience |
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