A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission

Abstract

Background: Transsphenoidal endoscopic surgery is the first-line treatment forgrowth hormone-secreting adenomas. The aim of the study is to analyze theresults of transsphenoidal endoscopic approach for acromegaly and to determinethe predictive factors for remission.Methods: A single-center retrospective review was performed in patients whounderwent endoscopic transsphenoidal surgery for acromegaly between January2009 and January 2019. Demographic features, clinical presentation, histopathologyrecords, postoperative complications, pre- and postoperative radiologic,and endocrinological assessments were evaluated. The factors that influence theremission rates were investigated.Results: A total of 73 patients were operated via transsphenoidal endoscopicapproach. Cavernous sinus invasion was detected in 32 (43,8%) patients and57 (78%) patients had macroadenomas. Pathology specimens of the 27(36,9%) patients revealed dual staining adenomas with prolactin. A total of51 patients (69,8%) were in biochemical remission one year after surgery. Asecond operation was performed in 10 patients (13,6%) with residual tumorand without biochemical remission in the first year. 6 of these patients (60%)were in remission at the last follow-up. Transient diabetes insipidus wasobserved in 18 (24,6%) patients and rhinorrhea in 4 patients (5,4%) whichceased with conservative treatment. None of the patients had developedpanhypopituitarism. The presence of cavernous sinus invasion, preoperativeIGF-1, immediate postoperative GH, and 3 rd -month IGF-1 levels are predictivefor remission.Conclusion: Transsphenoidal endoscopic surgery is a safe and effective treatmentfor acromegaly. Reoperation should be considered in patients with residualtumor and without remission.