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Early postoperative basal serum GH level and the GH response to TRH in relation to the long‐term outcome of surgical treatment for acromegaly: a report on 39 patients
Author(s) -
VALDEMARSSON S.,
BRAMNERT M.,
CRONQUIST S.,
ELNER Å.,
ENEROTH C. M.,
HEDNER P.,
LINDVALLAXELSSON M.,
NORDSTRÖM C. H.,
STRÖMBLAD L. G.
Publication year - 1991
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/j.1365-2796.1991.tb00405.x
Subject(s) - acromegaly , medicine , basal (medicine) , surgery , pituitary adenoma , growth hormone , adenoma , hormone , insulin
. During a 10‐year period 39 patients with acromegaly, aged 23–73 years, underwent selective adenomectomy via a trans‐sphenoidal or transfrontal (one case) approach. Six to 12 months after the operation, the serum level of growth hormone (GH) was reduced to < 5 μg l −1 in 28 patients (74%) in at least two of three random samples and/or suppressed to < 3 μg l −1 during an oral glucose load, thus fulfilling the commonly used criteria for a successful operation. In 10 patients these criteria for adequate GH reduction were not fulfilled, but their median S‐GH level was reduced from 38 to 11 μg l −1 ( P < 0.01) after the operation. Surgery was successful in 11 of 13 (85%) patients with a microadenoma (< 10 mm in diameter), in 10 of 14 (71%) patients with an adenoma of diameter >> 10 mm but still enclosed in the sella, and in seven of 11 (64%) patients with locally invasive tumours. Impaired pituitary function was observed in 23% of the patients after surgery, independent of tumour size. In one patient the postoperative period was complicated by a lethal intracranial infection. During follow‐up for 1–10 years, four patients relapsed, after 1, 1.5, 6 and 9 years, respectively. Patients for whom surgery appeared to have been ineffective at the evaluation 6–12 months postoperatively, or who later relapsed were identified by early (within 7 d) postoperative serum GH with a sensitivity of 90 %. The accuracy for identification of a satisfactory outcome of surgery was 85%, and the predictive value was 90%. The corresponding values for the GH response to TRH measured 6–12 months postoperatively were 47, 40 and 54%, respectively. It is concluded that the basal level of serum GH measured 1–7 d postoperatively has higher sensitivity and specificity than the GH response to TRH 6–12 months postoperatively for evaluation of the effect of surgery on GH overproduction, and that it has a higher predictive power with regard to the long‐term outcome of surgery for acromegaly.