Evaluation of Factors Affecting Outcome in Growth Hormone–Secreting Pituitary Adenomas

Abstract

Introduction Management of functioning pituitary adenomas is challenging as they can present with features of an intracranial mass, systemic effects, or a combination of both. In this series, one of the largest in available literature from our country, we have analyzed our experience with surgical management of growth hormone (GH)-secreting pituitary adenomas and factors influencing their hormonal remission.

Materials and Methods The data of all functional pituitary adenomas operated at our institute from January 2002 to December 2011 were obtained from the case files of these patients. This was studied for various clinical-radiologic features, management stratagems, and clinical and hormonal outcomes.

Results Ninety-three patients of GH-secreting pituitary adenomas with a mean age of 32.7 years were included in the study. Fifty-three (57%) patients had headache at presentation; 46 (49%) had visual complaints, whereas menstrual irregularity was seen in majority of females. Mean GH level was 52.05 ng/mL. Fifty (53%) patients had invasive adenoma; 32 had cavernous sinus extension. Among 80 patients with hormonal follow-up, 43 (53.75%) achieved remission of GH level < 5 ng/mL.

Conclusion In this series, one of the largest of its kind, the main factors influencing unfavorable outcome include macroadenomas, invasiveness, high basal GH > 45 ng/mL levels, and mixed adenomas.

Keywords

pituitary adenomas - invasive adenoma - growth hormone–secreting adenomas - acromegaly

• References

• 1 Esposito V, Santoro A, Minniti G. , et al. Transsphenoidal adenomectomy for GH-, PRL- and ACTH-secreting pituitary tumours: outcome analysis in a series of 125 patients. Neurol Sci 2004; 25 (05) 251-256
• 2 Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary 1999; 2 (01) 29-41
• 3 John A, Kamal T, Edward R. Pituitary tumors-functioning and Nonfunctioning. In: Richard WH. , ed. Youmans Neurological Surgery. 6th ed, Vol 2. Philadelphia, PA: Elsevier Saunders; 2011. :chap 34
• 4 Fahlbusch R, Honegger J, Buchfelder M. Surgical management of acromegaly. Endocrinol Metab Clin North Am 1992; 21 (03) 669-692
• 5 Sheaves R, Jenkins P, Blackburn P. , et al. Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure. Clin Endocrinol (Oxf) 1996; 45 (04) 407-413
• 6 Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients. J Neurosurg 1988; 68 (06) 854-867
• 7 Losa M, Oeckler R, Schopohl J, Müller OA, Alba-Lopez J, von Werder K. Evaluation of selective transsphenoidal adenomectomy by endocrinological testing and somatomedin-C measurement in acromegaly. J Neurosurg 1989; 70 (04) 561-567
• 8 Tindall GT, Oyesiku NM, Watts NB, Clark RV, Christy JH, Adams DA. Transsphenoidal adenomectomy for growth hormone-secreting pituitary adenomas in acromegaly: outcome analysis and determinants of failure. J Neurosurg 1993; 78 (02) 205-215
• 9 Eastman RC, Gorden P, Glatstein E, Roth J. Radiation therapy of acromegaly. Endocrinol Metab Clin North Am 1992; 21 (03) 693-712
• 10 Laws Jr ER, Thapar K. Recurrent pituitary adenomas. In: Landolt AM, Vance ML, Reilly PL. , eds. Pituitary Adenomas. Edinburgh, UK: Churchill Livingstone; 1996: 385-94
• 11 Möller-Goede DL, Brändle M, Landau K, Bernays RL, Schmid C. Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome. Eur J Endocrinol 2011; 164 (01) 37-43
• 12 Minniti G, Jaffrain-Rea ML, Esposito V, Santoro A, Tamburrano G, Cantore G. Evolving criteria for post-operative biochemical remission of acromegaly: can we achieve a definitive cure? An audit of surgical results on a large series and a review of the literature. Endocr Relat Cancer 2003; 10 (04) 611-619
• 13 Kreutzer J, Vance ML, Lopes MB, Laws Jr ER. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab 2001; 86 (09) 4072-4077
• 14 Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab 1998; 83 (10) 3411-3418
• 15 Swearingen B, Barker II FG, Katznelson L. , et al. Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab 1998; 83 (10) 3419-3426
• 16 Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg 1998; 89 (03) 353-358