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Endoscopic Pituitary Surgery Effective and Safe as the Primary Treatment for Acromegaly: Presented at ECE

By Chris Berrie

BERLIN -- May 5, 2008 -- Surgery carried out by an endoscopic endonasal approach to the sella is well tolerated and remains the first-line therapy for cure of patients with acromegaly, according to a prospective study presented here on May 4th at the 10th European Congress of Endocrinology (ECE).

The procedure leads to stable and rapid remission in the majority of patients with acromegaly, researchers reported in a presentation on April 3.

Acromegaly is a potentially severe and debilitating multisystem disorder associated with considerable morbidity and increased mortality. The condition most commonly involves pituitary adenoma. The main aim of treatment is to reverse these symptoms and signs through removal of the tumour, thus preventing disease recurrence and improving patient survival.

Principal investigator Marco Faustini-Fustini, MD, Resident Endocrinologist, Department of Medicine and Neurological Sciences, Centre for Surgery of Pituitary Tumours, Bellaria Hospital, Bologna, Italy, presented the findings.

"When we began the study 10 years ago, there was a impressive improvement not only in the medical approach for acromegaly, but also there were some improvements in the surgical approach through the sella, namely the endoscopic, endonasal approach," Dr. Faustini-Fustini explained.

Therefore, his research team conducted a study to assess whether these recent advances can obtain remission and stable disease control according to strict criteria for cure of patients with acromegaly.

The study included 152 consecutive patients with acromegaly (median age, 46 years; male, 43%), 31.6% of whom had microadenomas. In all, 17.1% underwent surgery for residual tumour, while the remaining 82.9% had no previous intervention. Based on tumour extension, these pituitary adenomas were classified as grade 0 (18.4%), grade 1 (9.9%), grade 2 (57.5%), grade 3 (13.2%), and grade 4 (1.3%).

At median follow-up of 34 months after surgery, the overall remission rate was 68% using biochemical criteria for cure based on mean and nadir growth hormone with normal insulin-like growth factor I levels. Partial surgical success was obtained in a further 21%, as a clinically relevant improvement with or without residual tumour. The remaining 11% showed active disease with residual tumour on magnetic resonance imaging.

In 2.7% of patients, surgery led to partial hypopituitarism, with transient and permanent diabetes in 4.0% and 1.3%, respectively. Postsurgical hyponatraemia due to syndrome of inappropriate antidiuresis was seen in 5.2%, with a 0.0% mortality rate.

Dr. Faustini-Fustini stressed that 17% of these patients underwent surgery for the second time, where the second intervention is often more difficult than the first. He also noted, "In the surgical approach two thirds of patients were cured in a few days, and the cost of the treatment was 10 times less than the primary medical therapy for acromegaly."

Thus, when surgery is carried out by a one-nostril endoscopic, endonasal, transphenoidal procedure by a team of expert surgeons working with endocrinologists, pathologists, and neuroradiologists, remission can be obtained in about two thirds of patients with acromegaly.

Finally, he added, "This new approach also permits a wide view of the sella by means of the endoscope, and so also in the case of parasella extension of the tumour, the operator can reach the complete removal of the tumour."


[Presentation title: Endoscopic Pituitary Surgery as the Primary Treatment for Acromegaly: A Prospective Study in a Specialised Centre. Abstract P482]

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