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J Neurol Surg B Skull Base
DOI: 10.1055/a-2319-0344
Original Article

Early Predictors of Remission in Acromegaly Patients after Pure Endoscopic Endonasal Transsphenoidal Surgery

Nuri Eralp Cetinalp 
1   Department of Neurosurgery, Cukurova University Faculty of Medicine, Balcali, Adana, Türkiye
,
Gamze Akkus
2   Division of Endocrinology, Department of Internal Medicine, Cukurova University Faculty of Medicine, Adana, Türkiye
,
Gulsah Seydaoglu
3   Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Türkiye
,
Kerem Mazhar Ozsoy
1   Department of Neurosurgery, Cukurova University Faculty of Medicine, Balcali, Adana, Türkiye
,
Mevlana Akbaba
1   Department of Neurosurgery, Cukurova University Faculty of Medicine, Balcali, Adana, Türkiye
,
Okay Baykara
1   Department of Neurosurgery, Cukurova University Faculty of Medicine, Balcali, Adana, Türkiye
,
Kadir Oktay
1   Department of Neurosurgery, Cukurova University Faculty of Medicine, Balcali, Adana, Türkiye
,
Tahsin Erman
1   Department of Neurosurgery, Cukurova University Faculty of Medicine, Balcali, Adana, Türkiye
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Abstract

Objective Surgery is the first-line treatment in acromegaly but it takes months to confirm remission. It is crucial to determine remission early in order to inform the patient and plan further treatment options. We aimed to evaluate the predictors of remission at the early phase after endoscopic endonasal pituitary surgery in acromegaly patients.

Methods Fifty-four growth hormone (GH)-adenoma patients operated via pure endoscopic endonasal approach were analyzed in this observational study. We compared the basic clinical, radiological characteristics, and the preoperative and postoperative hormone levels in terms of remission according to current guidelines.

Results The surgical remission rate was 61.1%. When the patients were compared according to surgical remission, the age, gender, and immunohistochemical granulation type were found to be nonsignificant, while diabetes mellitus was more common (55.6 vs. 44.4%). The preoperative tumor volume (1.2 ± 0.9 vs. 4.1 ± 4.2 cm3) and postoperative GH and insulin-like growth factor-1 (IGF-1) levels were higher in the nonremission group (p < 0.05). We defined a number of cut-off values of both GH and IGF-1 levels to predict remission at the postoperative phase. Age standardized regression analyses showed that postoperative day 1 (POD-1) GH levels (odds ratio [OR]: 8.9; 95% confidence interval [CI]: 1.99–40.0, p = 0.004) and tumor volume (OR: 3.14; 95% CI: 1.09–9.0, p = 0.034) were found to be significant independent predictors for remission.

Conclusion We demonstrated that tumor volume and POD-1 GH levels are independent predictors of remission in acromegaly patients operated via the pure endoscopic endonasal technique and may be used as an early marker of remission, and this may lead to taking adjuvant medical therapies early into account to improve prognosis.

Keywords

acromegaly - remission - pituitary adenoma - endoscopic endonasal


Publication History

Received: 04 February 2024

Accepted: 23 April 2024

Accepted Manuscript online:
03 May 2024

Article published online:
23 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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