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Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study
Eva C Coopmans1, Mark R Postma2, Thalijn L C Wolters3
1Department of Medicine, Endocrinology section, Pituitary Center Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.
The Journal of Clinical Endocrinology and Metabolism
|February 5, 2021
Summary
Predicting surgical success in acromegaly is crucial. Larger tumor size and higher growth hormone levels at diagnosis reduce the chances of remission after transsphenoidal surgery (TSS).
Area of Science:
- Endocrinology and Neurosurgery
- Biochemical and Clinical Research
Background:
- Transsphenoidal surgery (TSS) is the primary treatment for acromegaly.
- Early identification of patients unlikely to achieve surgical cure is vital for managing expectations and planning further treatment.
- Predicting remission post-TSS informs patient counseling and therapeutic strategies.
Purpose of the Study:
- To identify predictors of remission following transsphenoidal surgery (TSS) in patients with acromegaly.
- To distinguish factors influencing early biochemical remission and long-term remission after surgery.
Main Methods:
- Retrospective analysis of clinical data from 282 patients across three Dutch neurosurgical centers (2000 onwards).
- Multivariate regression models were employed to assess predictors of remission.
- Remission was defined by 2010 consensus criteria for early biochemical remission and age/sex-normalized IGF-1 for long-term remission.
Main Results:
- A larger maximum tumor diameter was significantly associated with a lower likelihood of achieving early biochemical remission (OR 0.91, P≤0.0001).
- Both larger maximum tumor diameter (OR 0.93, P=0.0022) and higher random growth hormone (GH) concentration at diagnosis (OR 0.98, P=0.0053) predicted a lower chance of long-term remission.
Conclusions:
- Maximum tumor diameter is a key predictor for both early and long-term remission after TSS in acromegaly.
- Random GH concentration at diagnosis is also a significant predictor for long-term remission.
- These factors are crucial for predicting surgical outcomes in acromegaly patients undergoing TSS.
