Outcome of surgical treatment for acromegaly performed by a single neurosurgeon and cumulative meta-analysis
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Boeving, Anke; Borba, LuizAlencar; Rodrigues, Adriane Maria; Orichowski, Elisa Brunner; Da Paz Filho, Gilberto; Santos, Carlos M Correa Dos; Boguszewski, Cesar Luiz
Description
The aim of this retrospective study was to evaluate the results of transsphenoidal surgery in a group of patients with acromegaly who were operated by the same neurosurgeon. Our results were compared to those from a cumulative meta-analysis of 10 series (1,632 patients) published between 1992-2005. We followed 28 patients (17M/11F; 44.1 ± 12.7 yr; 27 with macroadenomas; 86% being invasive) during 21.4 ± 17.6 months after treatment. Patients were classified according to disease activity as...[Show more]
dc.contributor.author | Boeving, Anke | |
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dc.contributor.author | Borba, LuizAlencar | |
dc.contributor.author | Rodrigues, Adriane Maria | |
dc.contributor.author | Orichowski, Elisa Brunner | |
dc.contributor.author | Da Paz Filho, Gilberto | |
dc.contributor.author | Santos, Carlos M Correa Dos | |
dc.contributor.author | Boguszewski, Cesar Luiz | |
dc.date.accessioned | 2015-12-08T22:17:00Z | |
dc.identifier.issn | 0004-2730 | |
dc.identifier.uri | http://hdl.handle.net/1885/30936 | |
dc.description.abstract | The aim of this retrospective study was to evaluate the results of transsphenoidal surgery in a group of patients with acromegaly who were operated by the same neurosurgeon. Our results were compared to those from a cumulative meta-analysis of 10 series (1,632 patients) published between 1992-2005. We followed 28 patients (17M/11F; 44.1 ± 12.7 yr; 27 with macroadenomas; 86% being invasive) during 21.4 ± 17.6 months after treatment. Patients were classified according to disease activity as follows: 1) controlled (CD): basal or mean GH < 2.5 ng/ml or nadir GH (OGTT) < 1 ng/ml and normal IGF-1; 2) uncontrolled (UCD): basal or mean GH > 2.5 ng/ml or nadir GH > 1 ng/ml and elevated IGF-1; 3) inadequately controlled (ICD): normal GH and elevated IGF-1 or elevated GH and normal IGF-1. After surgery, GH levels decreased from 61.7 ± 101.1 ng/ml to 7.2 ± 13.7 ng/ml (p< 0.001) and mean IGF-1 from 673.1 ± 257.7 ng/ml to 471.2 ± 285 ng/ml (p= 0.01). Biochemical remission rate was 57% [10 (35.5%) patients with CD and 6 (21.5%) with ICD], similar to the mean remission rate observed in the meta-analysis of surgical outcome of macroadenomas. Seven of 28 patients were submitted to surgical re-intervention (4 had been previously operated elsewhere and 3 by our neurosurgeon), with CD observed in 5 (71.5%) on follow-up. Cavernous sinuses invasion was more prevalent in UCD and ICD, whereas infundibular stalk deviation occurred only in patients with UCD. Remission rate was significantly higher in series where all surgical procedures were performed by the same surgeon (66% vs. 49%; p< 0.05). Thus, the surgeon's experience significantly improves the surgical outcome in acromegaly, especially in patients harboring large and invasive tumors, and re-intervention performed by an experienced surgeon should be considered in the algorithms for clinical management of this disease. | |
dc.publisher | Universidade de Sao Paulo, Faculdade de Medicina | |
dc.source | Arquivos Brasileiros de Endocrinologia e Metabologia | |
dc.subject | Keywords: biological marker; human growth hormone; somatomedin C; acromegaly; adenoma; adult; aged; article; blood; cancer invasion; clinical trial; epidemiology; evaluation; female; glucose tolerance test; growth hormone secreting adenoma; human; male; meta analys Acromegaly; Growth hormone; Neurosurgery; Pituitary neoplasms; Therapeutics | |
dc.title | Outcome of surgical treatment for acromegaly performed by a single neurosurgeon and cumulative meta-analysis | |
dc.type | Journal article | |
local.description.notes | Imported from ARIES | |
local.identifier.citationvolume | 50 | |
dc.date.issued | 2006 | |
local.identifier.absfor | 110999 - Neurosciences not elsewhere classified | |
local.identifier.ariespublication | u4693331xPUB78 | |
local.type.status | Published Version | |
local.contributor.affiliation | Boeving, Anke, Universidade Federal do Parana | |
local.contributor.affiliation | Borba, LuizAlencar, Universidade Federal do Parana | |
local.contributor.affiliation | Rodrigues, Adriane Maria, Universidade Federal do Parana | |
local.contributor.affiliation | Orichowski, Elisa Brunner, Universidade Federal do Parana | |
local.contributor.affiliation | Da Paz Filho, Gilberto, College of Medicine, Biology and Environment, ANU | |
local.contributor.affiliation | Santos, Carlos M Correa Dos, Universidade Federal do Parana | |
local.contributor.affiliation | Boguszewski, Cesar Luiz, Universidade Federal do Parana | |
local.description.embargo | 2037-12-31 | |
local.bibliographicCitation.issue | 5 | |
local.bibliographicCitation.startpage | 884 | |
local.bibliographicCitation.lastpage | 892 | |
local.identifier.doi | 10.1590/S0004-27302006000500009 | |
dc.date.updated | 2015-12-08T08:06:17Z | |
local.identifier.scopusID | 2-s2.0-33845787884 | |
Collections | ANU Research Publications |
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