Surgery for Acromegaly: The Outcome Based on Stringent Criteria of Remission

Acromegaly is a rare disease with increased mor-tality rate. Present literature documents the treatment of choice for acromegaly is surgery, curative in 91% of pituitary microadenomas and up to 73% of macroadenomas. The aim of this study was to present our experience in the diag-nosis and treatment of a series of patients suffer-ing from acromegaly, and to compare the results concerning control of disease with other series using modern criteria for therapy. Of fifty patients (31 men, 19 women) referring to the Mashhad Endo-crine Out-patient Clinic between 2001 and 2005, diagnosed with acrimegaly. 40 underwent sur-gery as initial therapy. We used a combination of modern, evidence-based remission criteria in-cluding basal GH below 2.5 µg/L (5 mU/L), a na-dir GH below than 1.0 µg/L (2 mU/L) after an oral glucose tolerance test, and normal age-related IGF-I levels 6 months after surgery for the definition of cure in our patients. Fifteen of the 40 patients operated (37.5%) remained in remission after just transsphenoidal surgery; 80% of patients with microadenomas but only 31.4% of patients with macroadenomas achieved remission; 50% intrasellar macroade-nomas showed remission, compared with only 21.7% extrasellar extended macroadenomas. The rate of biochemical ‘cure’ correlated with the magnitude of the initial GH levels, the tumor size and invasion. In conclusion, using stringent crite-ria of remission, our results compared well with similar series of microadenomas and intrasellar macroadenomas, whereas outcomes for extrasel-lar macroadenomas were less than satisfactory.