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- Title
Predictors of surgical outcome and early criteria of remission in acromegaly.
- Authors
Antunes, Ximene; Ventura, Nina; Camilo, Gustavo Bittencourt; Wildemberg, Luiz Eduardo; Guasti, Andre; Pereira, Paulo José M.; Camacho, Aline Helen Silva; Chimelli, Leila; Niemeyer, Paulo; Gadelha, Mônica R.; Kasuki, Leandro
- Abstract
Background: Transsphenoidal surgery (TSS) is the cornerstone of acromegaly treatment, however there are no robust predictors of surgical outcome and remission can only be defined three months after surgery.Purpose: To analyze if biochemical, demographical, radiological, and immunohistochemical characteristics are predictors of surgical remission and investigate if immediate postoperative GH and IGF-I levels can help defining remission earlier.Methods: Consecutive acromegaly patients submitted to TSS between 2013-2016 were evaluated. Remission criteria was defined as normal IGF-I and GH <1 mcg/L three months after surgery. Data of age, sex, GH and IGF-I levels, tumor volume, cavernous sinus invasion, T2-weighted signal, Ki-67, and granulation pattern were correlated with remission status. GH and IGF-I levels at 24, 48 h, and one week postoperative were evaluated as early criteria of remission.Results: Sixty-nine patients were included (84% macroadenomas) and surgical remission was achieved in 45%. No difference between cured and not cured patients concerning age, gender, preoperative GH or IGF-I levels, tumor volume, T2-weighted signal, Ki-67 and tumor granularity was observed. Remission was obtained in 20 of 36 (56%) of the non-invasive tumors, and in 3 of 16 (19%) of the invasive tumors (<italic>p</italic> = 0.017). A GH <1.57 mcg/L 48 h after surgery was able to predict remission with 93% sensitivity and 86% specificity and an IGF-I < 231% ULNR one week after surgery predicted remission with 86% sensitivity and 93% specificity.Conclusion: Cavernous sinus invasion is the only preoperative predictor of surgical remission. GH at 48 h and IGF-I one week after surgery can define earlier not cured patients.
- Publication
Endocrine (1355008X), 2018, Vol 60, Issue 3, p415
- ISSN
1355-008X
- Publication type
Article
- DOI
10.1007/s12020-018-1590-8