Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: Initial outcome and long-term results

被引:280
作者
Abosch, A
Tyrrell, JB
Lamborn, KR
Hannegan, LT
Applebury, CB
Wilson, CB
机构
[1] Univ Calif San Francisco, Dept Neurol Surg, Sch Med, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Dept Med, Sch Med, San Francisco, CA 94143 USA
关键词
D O I
10.1210/jc.83.10.3411
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Treatment of acromegaly has long been recognized as necessary to relieve symptoms, halt progression of deformities, and decompress the sella turcica. More recently, treatment strategies have focused on decreasing GH levels to a point at which mortality rates normalize, thereby redefining previous concepts of a cure. No surgical series to date has investigated the long-term effect of treatment on mortality rates. We retrospectively reviewed 254 consecutive patients with acromegaly who underwent transsphenoidal microsurgery of GH-secreting adenomas between 1974-1992. Seventy-six percent of these patients had basal GH levels <5 ng/mL within 30 days of surgery, and 24% had persistent disease, Multivariate analysis revealed that higher stage, grade, and preoperative GH levels were all predictive of persistence (P < 0.01). Long-term follow-up was obtained on 129 of the patients in initial remission. Of these, 9 (7%) had disease recurrence and 120 remained in remission. The incidence of major postoperative complications was 8% (2% permanent diabetes insipidus, 2% cerebrospinal fluid leaks requiring surgery, 2% meningitis, and 2% hypopituitarism), with no mortality. In contrast to the 2.4- to 4.8-fold increased mortality among untreated acromegalics, the mortality rate among patients with posttherapy GH levels <5 ng/mL was equivalent to that of age- and sex-matched controls. Aggressive ther apy to normalize GH levels should therefore be instituted at diagnosis.
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收藏
页码:3411 / 3418
页数:8
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