Predictors of biochemical remission after transsphenoidal surgery in a large cohort of acromegaly patients.

Autor: Balagurunath K; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA., Chrenek R; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Gerstl J; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA., Corrales CE; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA., Laws ER; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Mekary RA; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.; School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, Massachusetts, USA., Smith TR; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Hong CS; Computational Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA. chong6@mgb.org.; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. chong6@mgb.org.; Department of Neurosurgery, VA Boston Healthcare System, Boston, United States of America. chong6@mgb.org.
Jazyk: angličtina
Zdroj: Pituitary [Pituitary] 2024 Dec 21; Vol. 28 (1), pp. 2. Date of Electronic Publication: 2024 Dec 21.
DOI: 10.1007/s11102-024-01472-2
Abstrakt: Purpose: The objective of this study was to characterize the clinical characteristics and factors predictive of biochemical remission in patients with symptomatic acromegaly undergoing transsphenoidal surgery (TSS) at an academic tertiary care center, as defined by the 2022 Acromegaly Consensus Conference guidelines.
Methods: In this single institution, longitudinal, retrospective study, a large cohort of 158 patients with a preoperative diagnosis of acromegaly undergoing surgery at a large, academic, tertiary care center were examined. We excluded 38 patients as IGF-1 testing was performed less than 12 weeks postoperatively.
Results: The majority of tumors were intrasellar macroadenomas (75%), receiving endoscopic surgery (98.3%). Patients who failed remission appeared to have higher raw IGF-1 levels preoperatively (732 ± 313 ng/mL) compared to those who attained remission (278 ± 313 ng/mL), and trended towards higher rates of GH hypersecretion (93.1% vs. 78.4%). Patients failing remission had higher GH levels and IGF-1 levels postoperatively and experienced a lower percentage reduction in raw IGF-1 levels. Multivariable logistic regression demonstrated that the magnitude of preoperative IGF-1 (OR: 1.001, 95% CI: 1.00, 1.003) and the percentage change in IGF-1 (OR: 1.021, 95% CI: 1.01, 1.04) were predictive of remission failure. Radiographic characteristics such as tumor size, suprasellar extension, and location were not necessarily predictive of worse postoperative outcomes.
Conclusions: Lesions which failed to achieve biochemical remission appeared to display distinctive preoperative endocrinological characteristics, with preoperative IGF-1 levels and percentage changes in IGF-1 levels being predictive of biochemical remission status.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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