Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Tyler Cardinal, Casey Collet, Michelle Wedemeyer, Peter A. Singer, Martin Weiss, Gabriel Zada, John D. Carmichael
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	acromegaly transsphenoidal resection growth hormone IGF- I hormonal remission Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/bcb6d8b8319445fbb22110037ee1cece
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:bcb6d8b8319445fbb22110037ee1cece
record_format	dspace
spelling	oai:doaj.org-article:bcb6d8b8319445fbb22110037ee1cece2021-11-18T07:15:39ZPostoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly1664-239210.3389/fendo.2021.743052https://doaj.org/article/bcb6d8b8319445fbb22110037ee1cece2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.743052/fullhttps://doaj.org/toc/1664-2392PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.Tyler CardinalCasey ColletMichelle WedemeyerPeter A. SingerPeter A. SingerMartin WeissGabriel ZadaJohn D. CarmichaelJohn D. CarmichaelFrontiers Media S.A.articleacromegalytranssphenoidal resectiongrowth hormoneIGF- Ihormonal remissionDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acromegaly transsphenoidal resection growth hormone IGF- I hormonal remission Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	acromegaly transsphenoidal resection growth hormone IGF- I hormonal remission Diseases of the endocrine glands. Clinical endocrinology RC648-665 Tyler Cardinal Casey Collet Michelle Wedemeyer Peter A. Singer Peter A. Singer Martin Weiss Gabriel Zada John D. Carmichael John D. Carmichael Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly
description	PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.
format	article
author	Tyler Cardinal Casey Collet Michelle Wedemeyer Peter A. Singer Peter A. Singer Martin Weiss Gabriel Zada John D. Carmichael John D. Carmichael
author_facet	Tyler Cardinal Casey Collet Michelle Wedemeyer Peter A. Singer Peter A. Singer Martin Weiss Gabriel Zada John D. Carmichael John D. Carmichael
author_sort	Tyler Cardinal
title	Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly
title_short	Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly
title_full	Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly
title_fullStr	Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly
title_full_unstemmed	Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly
title_sort	postoperative gh and degree of reduction in igf-1 predicts postoperative hormonal remission in acromegaly
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/bcb6d8b8319445fbb22110037ee1cece
work_keys_str_mv	AT tylercardinal postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT caseycollet postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT michellewedemeyer postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT peterasinger postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT peterasinger postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT martinweiss postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT gabrielzada postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT johndcarmichael postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly AT johndcarmichael postoperativeghanddegreeofreductioninigf1predictspostoperativehormonalremissioninacromegaly
_version_	1718423752907161600

Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

Ejemplares similares