[Trans-sphenoidal surgery in 95 acromegalic patients: clinical and radiological findings]

ABSTRACT

Acromegaly, a multisystem disease, produced by growth hormone [GH] secreting pituitary adenomas, has devastating effects shortening life expectancy; thus control of the disease is vital. Surgical removal of adenomas is the primary and standard treatment in these patients. In this study, results of trans-sphenoidal surgery in 95 patients admitted consecutively to the Shohada-e Tadjrish Hospital, over 9 years beginning 1996, were analyzed. Data were collected retrospectively from files of all patients admitted to our hospital, over 9 years, and operated using a trans-sphenoidal approach. Clinical and radiological evaluations were reviewed and intra-operative findings, postoperative complications, immediate hormonal assay results and long term follow ups were analyzed. Forty eight patients were female and 47 male [1/1 ratio] with mean age of 39.2 +/- 12 years. Acromegalic features were present in almost every patient with a mean duration of 46 +/- 43 months. Macroadenomas were discovered in 70 patients and microadenomas in the other 25; there was no mortality. Postoperative complications were as follows Temporary Dl in 80, CSF rhinorrhea in 11 and meningitis in 4 [all were managed conservatively with only one case of permanent Dl]; 79 patients had follow up [mean 13 +/- 12 months]; 64% of patients [76% of microadenomas and 62% of macroadenomas] had remission [post-operative GH < 5 ng/mL], but with remission criteria of GH < 2.5 ng/mL there was 51% remission rate [65% of microadenomas and 44% of macroadenomas]. In five patients, following initial surgery, there was recurrence after 1 to 4 years, which was controlled in 4 of with a second trans-sphenoidal surgery, with the remaining one case being referred for radiotherapy