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Clinical Endocrinology

Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients

Authors

  • Frédérique Albarel,

    1. Aix-Marseille Université, CNRS, CRN2M UMR 7286, 13344 Cedex 15, APHM, Hôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 Cedex 15, Marseille, France
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  • Frédéric Castinetti,

    1. Aix-Marseille Université, CNRS, CRN2M UMR 7286, 13344 Cedex 15, APHM, Hôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 Cedex 15, Marseille, France
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  • Isabelle Morange,

    1. Aix-Marseille Université, CNRS, CRN2M UMR 7286, 13344 Cedex 15, APHM, Hôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 Cedex 15, Marseille, France
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  • Bernard Conte-Devolx,

    1. Aix-Marseille Université, CNRS, CRN2M UMR 7286, 13344 Cedex 15, APHM, Hôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 Cedex 15, Marseille, France
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  • Jean Gaudart,

    1. Aix Marseille Univ, UMR912 SESSTIM, AP-HM, UF 6671 Biostatistiques, Marseille, France
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  • Henry Dufour,

    1. Aix-Marseille Université, APHM, Hôpital Timone, Service de neurochirurgie, Marseille, France
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  • Thierry Brue

    Corresponding author
    • Aix-Marseille Université, CNRS, CRN2M UMR 7286, 13344 Cedex 15, APHM, Hôpital Timone, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 Cedex 15, Marseille, France
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Correspondence: Thierry Brue, Department of Endocrinology, Timone Hospital, 264, rue Saint Pierre, 13385 Marseille, Cedex 05, France. Tel.: +33 491 386 597; Fax: +33 491 384 542; E-mail: thierry.brue@univ-amu.fr

Summary

Introduction

Given the new therapeutic options in acromegaly, it seemed important to evaluate the outcome of operated acromegalic patients today.

Objective

To analyse the characteristics and short- and long-term surgical outcome of patients who underwent transsphenoidal surgery for a growth hormone (GH)-secreting adenoma in our centre and to determine predictive factors of remission.

Design and patients

This retrospective 10-year study included 115 newly diagnosed acromegalic patients operated on at Timone University Hospital, Marseille, France, between 1997 and 2007.

Measurements

Initial and long-term outcomes were evaluated using stringent and current remission criteria, associating GH nadir after oral glucose tolerance test <0·4 μg/l and normal insulin-like growth factor-1 (IGF-1) at 3 months, and a normal IGF-1 at the end of follow-up (52·4 ± 36·8 months, median 41 months, range 6·7–135·4 months, n = 99).

Results

At the end of follow-up, 90·9% of patients had controlled disease. Overall, 49·5% of patients were in long-term remission after surgery alone, and only 2·0% of patients experienced recurrent disease. Multivariate predictors of 3-month remission included mean GH at diagnosis (P = 0·033), tumour invasion (P = 0·013) and surgeon report of incomplete or uncertain macroscopic resection (P = 0·003 and P = 0·047, respectively). Multivariate predictors at diagnosis of long-term remission included mean GH level (P = 0·048), adenoma size (P = 0·007) and absence of pituitary deficit (P = 0·026).

Conclusions

In long-term follow-up after surgery of acromegaly, half of the patients achieved remission after surgery alone and more than 90% had their disease controlled. With stringent 3-month remission criteria, recurrence was rare.

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