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Age- and Sex-Specific Differences as Predictors of Surgical Remission Among Patients With Acromegaly
Se Hee Park1,2, Cheol Ryong Ku1,3,4, Ju Hyung Moon3,4,5
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Context:
Sex and age are factors conferring resistance to medical treatment in patients with acromegaly. However, their impact on outcomes of transsphenoidal-selective adenomectomy (TSA) has not been evaluated.
Objective:
To analyze age- and sex-related differences concerning surgical outcomes of growth hormone (GH)-secreting pituitary adenomas.
Design:
Retrospective.
Setting:
Single-center tertiary hospital.
Participants:
Patients with acromegaly (n = 463) who underwent TSA between January 2000 and July 2014.
Intervention:
TSA.
Main Outcome Measurements:
Tumor characteristics and surgical outcomes.
Results:
Sex differences existed in the baseline insulinlike growth factor-1 levels and the mean tumor size. Overall, surgical remission rates were 89.7% and 76.5% in male and female patients, respectively (P < 0.001). Total tumor tissue resection was performed in 92.6% and 85.8% of male and female participants, respectively (P = 0.021). Premenopausal women had a higher proportion of pituitary adenoma with cavernous sinus invasion than did men aged <50 years (35.3% vs 21.7%, P = 0.007). In immediate postoperative, 75-g oral glucose tolerance tests, fewer premenopausal women reached <1 ng/dL nadir GH levels than did men aged <50 years (59.9% vs 87.7%, P < 0.001). Surgical results were similar in both sexes among older patients (≥50 years). However, premenopausal women had significantly lower long-term remission rates than did men aged <50 years (69.3% vs 88.0%, P < 0.001).
Conclusion:
Premenopausal women with acromegaly tend to have larger tumors, more aggressive tumor types, and lower remission rates than do men. However, further studies on the clinical implications are needed.
