Acromegaly: Reassessment of the Long-term Therapeutic Effectiveness of Transsphenoidal Pituitary Surgery

Abstract

Of 11 patients with active acromegaly treated with transsphenoidal selective pituitary adenomectomy, 4 failed to show evidence of clinical improvement. An additional 4 patients showed clinical and biochemical improvement after the surgical procedure but, with more prolonged follow-up, showed a recurrence of acromegaly. Only 3 patients had prolonged clinical and biochemical evidence of improvement; they had glucose suppressed growth hormone concentrations of 1.0, 2.7 and 2.8 ng/ml 22, 40 and 24 mo., respectively, after the surgical procedure. Two of these 3 patients showed an increase in growth hormone concentration after TRA injection, suggesting a possible eventual relapse. The data also clearly indicated a need for more rigorous criteria for biochemical cure of acromegaly than those used previously. Study of 20 healthy volunteers showed that growth hormone concentration should normally be suppressible to < 2.0 ng/ml after 100 g oral glucose.