Premium
TREATMENT OF ACROMEGALY BY TRANS‐SPHENOIDAL OPERATION, 90‐YTTRIUM IMPLANTATION AND BROMOCRIPTINE: RESULTS IN 230 PATIENTS
Author(s) -
QUABBE HJ.
Publication year - 1982
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1982.tb03154.x
Subject(s) - bromocriptine , acromegaly , medicine , basal (medicine) , surgery , complication , endocrine system , endocrinology , urology , prolactin , growth hormone , hormone , insulin
SUMMARY Two hundred and thirty patients with acromegaly were diagnosed and treated in a prospective cooperative study in twelve university clinics. Primary treatment was: trans‐sphenoidal surgery (152 patients), trans‐sphenoidal surgery with additional cryotherapy (eighteen patients), Yttrium‐90‐implantation (thirty patients), bromocriptine (thirty patients). The results of endocrine assessment before treatment and 6 months after operation, 90‐Y implantation or commencement of bromocriptine therapy are reported. The best results (low GH, no or little deterioration of pituitary function, low complication rate) were achieved by trans‐sphenoidal surgery, especially in patients with intrasellar tumours (basal GH < 5 ng/ml in 59·7%). Results were less good with increasing tumour size. Additional cryosurgery was accompanied by a high rate of anterior pituitary insufficiency and is no longer employed. Yttrium‐90‐implantation resulted in less improvement in GH levels (basal GH < 5 ng/ml in 51·7. of patients with intrasellar tumours), a high rate of pituitary insufficiency and more complications. Bromocriptine treatment was least effective in lowering GH concentrations (basal GH < 5 ng/ml in 33% of patients with intrasellar tumours). Different criteria for treatment success were compared. In the entire group, basal GH concentrations below 5 ng/ml were attained in 51·7. of all patients whose values were higher than this prior to treatment. Suppressibility of GH below 2 ng/ml during glucose loading occurred in only 34·9%. An abnormal GH response to TRH/LHRH was present in 47·2. before and in 43·4% after/during treatment. The prognostic significance of this latter finding must be evaluated by further study.