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Recurrence following transsphenoidal surgery for acromegaly
M Buchfelder1, S Brockmeier, R Fahlbusch
1Neurochirurgische Klinik, Universität Erlangen-Nürnberg, FRG.
Hormone Research
|January 1, 1991
Summary
Transsphenoidal adenomectomy success in acromegaly patients is best predicted by normal glucose-induced growth hormone (GH) suppression post-surgery. This oral glucose tolerance test (OGTT) offers superior long-term prognostic value over basal GH measurements for detecting recurrence.
Area of Science:
- Endocrinology
- Neurosurgery
Background:
- Transsphenoidal adenomectomy is a primary treatment for pituitary adenomas causing acromegaly.
- Assessing long-term surgical success and recurrence risk is crucial for patient management.
Observation:
- 61 patients with initially normal post-operative basal serum growth hormone (GH) were followed for a mean of 6.0 years.
- GH levels, oral glucose tolerance tests (OGTT), and somatomedin C were monitored.
- Four patients showed increased basal GH; 43 maintained normal GH suppression post-OGTT.
Findings:
- Only 2 patients with initially normal OGTT suppression showed transient inadequate suppression later.
- No clinical recurrence of acromegaly or abnormal somatomedin C levels were observed in these cases.
- Normal glucose-induced GH suppression shortly after surgery strongly indicated sustained remission.
Implications:
- Recurrence of active acromegaly is unlikely in patients with early post-operative normal GH suppression via OGTT.
- OGTT is a more reliable prognostic indicator than basal GH levels for surgical success in acromegaly.
- This supports using OGTT for earlier and clearer assessment of surgical outcomes in acromegaly patients.