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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(05): 301-306
DOI: 10.1590/0004-282X20170035
ARTICLES

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Seguimento de longo prazo de adenomas hipofisários secretores do hormçnio do crescimento submetidos à cirurgia endoscópica endonasal
Caroline Martins dos Santos Leopoldo
1   Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo SP, Brasil;
,
Felippe Martins dos Santos Leopoldo
1   Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo SP, Brasil;
,
Américo Rubens Leite dos Santos
2   Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo SP, Brasil;
,
José Carlos Esteves Veiga
2   Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Cirurgia, Disciplina de Neurocirurgia, São Paulo SP, Brasil;
,
José Viana Lima Junior
3   Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Medicina, Disciplina de Endocrinologia, São Paulo SP, Brasil;
,
Nilza Maria Scalissi
3   Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Medicina, Disciplina de Endocrinologia, São Paulo SP, Brasil;
,
Paulo Roberto Lazarini
4   Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Otorrinolaringologia São Paulo SP, Brasil.
,
Ricardo Landini Lutaif Dolci
4   Faculdade de Ciências Médicas, Santa Casa de São Paulo, Departamento de Otorrinolaringologia São Paulo SP, Brasil.
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ABSTRACT

Objective

The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas.

Methods

A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up.

Results

The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke.

Conclusion

The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.

RESUMO

Objetivo

O objetivo do estudo é analisar os resultados da cirurgia de ressecção endoscópica transesfenoidal para adenomas secretores do hormçnio do crescimento (GH).

Métodos

Revisão retrospectiva baseada em análise de prontuários de 23 pacientes acromegálicos submetidos à cirurgia endoscópica. Remissão foi definida por GH < 1ng/ml, nadir de GH ≤ 0,4ng/ml no teste oral de tolerância a glicose e IGF-1 normal para idade.

Resultados

A taxa de remissão endocrinológica foi 39,1%. Enquanto todos microadenomas alcançaram controle hormonal, apenas um terço dos macroadenomas obtiveram remissão. Extensão suprasselar, invasão do seio cavernoso e altos níveis de GH foram associados a menores taxas de controle da doença. A complicação mais comum foi diabetes insipidus e a mais grave foi acidente vascular encefálico isquêmico.

Conclusão

A abordagem endoscópica transesfenoidal é segura e efetiva para controle de adenomas hipofisários secretores de GH. A abordagem ao seio cavernoso pode aumentar a morbidade da cirurgia. Extensões suprasselares e no seio cavernoso podem dificultar a ressecção completa e o controle da doença.

acromegaly - growth hormone-secreting pituitary adenoma - endoscopy
acromegalia - adenoma hipofisário secretor de hormçnio do crescimento - endoscopia


Publikationsverlauf

Eingereicht: 16. September 2016

Angenommen: 24. Januar 2017

Artikel online veröffentlicht:
05. September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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