Acromegaly: factors affecting the long term outcome after surgical treatment

Survival and clinical status in 105 acromegalic patients followed for up to 24 years after surgery is assessed against serum growth hormone (GH) levels and other factors. Primary treatment was at first (90)Yttrium implants or craniotomy, later transsphenoidal operation. GH levels were similar for each method, and the results were combined. Relief of presenting symptoms and tumour clearance related to early post-operative GH levels. Although the level at the last follow-up influenced clinical status at 10 years (P = 0.01), the major contributor was the age at diagnosis (P = 0.0002). Ten year survival was more likely when the final GH level was less than 5mug/l and at this level no tumour recurred. With GH less than 2 mug/l survival rate was higher and clinical status better. With GH between 2 and 5 mug/l radiotherapy may be indicated; levels of Insulin-like Growth Factor I help in this decision. A plan of management is suggested.