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J Neurol Surg B Skull Base 2024; 85(04): 389-396
DOI: 10.1055/a-2081-1427
Original Article

Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Yuanming Geng‡   *
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Qian Dong‡   *
2   School of Nursing, Bengbu Medical College, Anhui, People's of Republic of China
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Zixiang Cong‡   *
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Junhao Zhu
4   Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
,
Zhenxing Li
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Chaonan Du
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Feng Yuan
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Xinrui Zeng
4   Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
,
Alleyar Ali
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Jin Yang 
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Chao Tang
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Chiyuan Ma    *
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
4   Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
5   School of Medicine, Southeast University, Nanjing, People's Republic of China
6   Department of Neurosurgery, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, People's Republic of China
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Abstract

Objective Biochemical remission rates of endoscopic endonasal transsphenoidal surgery (EETS) and its associated predictive factors were evaluated in patients with somatotrophin pituitary adenomas.

Methods The patients who underwent EETS in Jinling Hospital were identified between 2011 and 2020. The surgeons' experience, preoperative insulin-like growth factor 1 (IGF-1), basal growth hormone (GH) levels, nadir GH levels, and the tumor characteristics were analyzed for their relationships with endocrine outcomes. Total 98 patients were included for single factor analysis and regression analysis. They were divided into three groups according to the admission chronologic order.

Results The overall remission rate of the patients was 57% (56/98) for all the patients over 10 years. In the single factor analysis, we found that the tumor size, cavernous invasion, and sellar invasion were valuable to predict the endocrine outcome after surgery. As for the suprasellar invasion, no significant difference was found between the noninvasive group and the invasive group. The preoperative IGF-1 level (p = 0.166), basal GH level (p = 0.001), and nadir GH level (p = 0.004) were also different between the remission group and the nonremission group in the single factor analysis. The logistic regression analysis indicated that the preoperative nadir GH (odds ratio = 0.930, 95% confidence interval = 0.891–0.972, p = 0.001) was a significant predictor for the endocrine outcomes after surgery.

Conclusion The surgeons' experience is an important factor that can affect the patients' endocrine outcomes after surgery. The macroadenomas with lateral invasion are more difficult to cure. Patients with higher preoperative nadir GH levels are less likely to achieve remission.

Keywords

pituitary adenoma - acromegaly - growth hormone - cavernous sinus - invasion - Knosp - endoscopic - transsphenoidal surgery

Ethical Approval and Consent to Participate

All patients provided written informed consent. The Institutional Review Board at Jinling Hospital approved the study.


Consent for Publication

The authors declare that the manuscript has not been submitted for publication elsewhere, in whole or in part, in any language. All authors have contributed to, read, and approved the enclosed manuscript.


Authors' Contributions

Y.G., Q.D., Z.C., J.Z., Z.L., C.D., F.Y., X.Z., A.A., J.Y., C.T., and C.M. all contributed to the review of relevant literature, writing, editing, and/or revising of the manuscript.


* These authors contributed equally to this work and share first authorship.




Publication History

Received: 08 February 2023

Accepted: 22 April 2023

Accepted Manuscript online:
26 April 2023

Article published online:
30 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 de Herder WW. The history of acromegaly. Neuroendocrinology 2016; 103 (01) 7-17
    CrossrefPubMedGoogle Scholar
  • 2 Melmed S, Bronstein MD, Chanson P. et al. A consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol 2018; 14 (09) 552-561
    CrossrefPubMedGoogle Scholar
  • 3 Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest 2009; 119 (11) 3189-3202
    CrossrefPubMedGoogle Scholar
  • 4 Katznelson L, Laws Jr ER, Melmed S. et al; Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99 (11) 3933-3951
    CrossrefPubMedGoogle Scholar
  • 5 Antunes X, Ventura N, Camilo GB. et al. Predictors of surgical outcome and early criteria of remission in acromegaly. Endocrine 2018; 60 (03) 415-422
    CrossrefPubMedGoogle Scholar
  • 6 Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane Jr JA. Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab 2013; 98 (08) 3190-3198
    CrossrefPubMedGoogle Scholar
  • 7 Fathalla H, Cusimano MD, Di Ieva A. et al. Endoscopic versus microscopic approach for surgical treatment of acromegaly. Neurosurg Rev 2015; 38 (03) 541-548 , discussion 548–549
    CrossrefPubMedGoogle Scholar
  • 8 Chen CJ, Ironside N, Pomeraniec IJ. et al. Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir (Wien) 2017; 159 (11) 2193-2207
    CrossrefPubMedGoogle Scholar
  • 9 Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33 (04) 610-617 , discussion 617–618
    CrossrefPubMedGoogle Scholar
  • 10 Eseonu CI, ReFaey K, Garcia O, Salvatori R, Quinones-Hinojosa A. Comparative cost analysis of endoscopic versus microscopic endonasal transsphenoidal surgery for pituitary adenomas. J Neurol Surg B Skull Base 2018; 79 (02) 131-138
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Gao H, Liu C, Zhang Y. Neuro-endoscope for skull base tumors. Clin Neurol Neurosurg 2018; 170: 102-105
    CrossrefPubMedGoogle Scholar
  • 12 Sarkar S, Rajaratnam S, Chacko G, Chacko AG. Endocrinological outcomes following endoscopic and microscopic transsphenoidal surgery in 113 patients with acromegaly. Clin Neurol Neurosurg 2014; 126 (126) 190-195
    CrossrefPubMedGoogle Scholar
  • 13 Wagenmakers MA, Netea-Maier RT, van Lindert EJ, Pieters GF, Grotenhuis AJ, Hermus AR. Results of endoscopic transsphenoidal pituitary surgery in 40 patients with a growth hormone-secreting macroadenoma. Acta Neurochir (Wien) 2011; 153 (07) 1391-1399
    CrossrefPubMedGoogle Scholar
  • 14 Campbell PG, Kenning E, Andrews DW, Yadla S, Rosen M, Evans JJ. Outcomes after a purely endoscopic transsphenoidal resection of growth hormone-secreting pituitary adenomas. Neurosurg Focus 2010; 29 (04) E5
    CrossrefPubMedGoogle Scholar
  • 15 Hofstetter CP, Mannaa RH, Mubita L. et al. Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurg Focus 2010; 29 (04) E6
    CrossrefPubMedGoogle Scholar
  • 16 Shin SS, Tormenti MJ, Paluzzi A. et al. Endoscopic endonasal approach for growth hormone secreting pituitary adenomas: outcomes in 53 patients using 2010 consensus criteria for remission. Pituitary 2013; 16 (04) 435-444
    CrossrefPubMedGoogle Scholar
  • 17 Phan K, Xu J, Reddy R, Kalakoti P, Nanda A, Fairhall J. Endoscopic endonasal versus microsurgical transsphenoidal approach for growth hormone-secreting pituitary adenomas-systematic review and meta-analysis. World Neurosurg 2017; 97 (97) 398-406
    CrossrefPubMedGoogle Scholar
  • 18 Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol 2005; 152 (03) 379-387
    CrossrefPubMedGoogle Scholar
  • 19 Shen M, Tang Y, Shou X. et al. Surgical results and predictors of initial and delayed remission for growth hormone-secreting pituitary adenomas using the 2010 consensus criteria in 162 patients from a single center. World Neurosurg 2018; 2018: S1878-8750 (18)32738-4
    PubMedGoogle Scholar
  • 20 Kempf J, Schmitz A, Meier A. et al. Adenoma size and postoperative IGF-1 levels predict surgical outcomes in acromegaly patients: results of the Swiss Pituitary Registry (SwissPit). Swiss Med Wkly 2018; 148: w14653
    PubMedGoogle Scholar
  • 21 Unal TC, Aydoseli A, Ozgen U. et al. A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission. Br J Neurosurg 2021; 2021: 1-6
    CrossrefPubMedGoogle Scholar
  • 22 Cardinal T, Rutkowski MJ, Micko A. et al. Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly. Neurosurg Focus 2020; 48 (06) E10
    CrossrefPubMedGoogle Scholar
  • 23 Shen SC, Shen CC, Pu TW, Cheng WY. Long-term effects of intracapsular debulking and adjuvant somatostatin analogs for growth hormone-secreting pituitary macroadenoma: 10 years of experience in a single institute. World Neurosurg 2019; 126 (126) e41-e47
    CrossrefPubMedGoogle Scholar
  • 24 Kim EH, Oh MC, Lee EJ, Kim SH. Predicting long-term remission by measuring immediate postoperative growth hormone levels and oral glucose tolerance test in acromegaly. Neurosurgery 2012; 70 (05) 1106-1113 , discussion 1113
    CrossrefPubMedGoogle Scholar
  • 25 Albarel F, Castinetti F, Morange I. et al. Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients. Clin Endocrinol (Oxf) 2013; 78 (02) 263-270
    CrossrefPubMedGoogle Scholar
  • 26 Jane Jr JA, Starke RM, Elzoghby MA. et al. Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab 2011; 96 (09) 2732-2740
    CrossrefPubMedGoogle Scholar
  • 27 Tang C, Zhong C, Cong Z. et al. MEG3 is associated with gsp oncogene regulation of growth hormone hypersecretion, proliferation and invasiveness of human GH-secreting adenomas. Oncol Lett 2019; 17 (03) 3495-3502
    PubMedGoogle Scholar