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Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure

Acromegaly is a systemic disease that requires multidisciplinary treatment to achieve the best clinical outcome. This study aimed to evaluate the outcomes of the endoscopic transsphenoidal approach (TSA) as the primary treatment for somatotroph adenomas and further investigate patients who had subop...

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Autores principales: Yan, Jiun-Lin, Chen, Mao-Yu, Chen, Yao-Liang, Chuang, Chi-Cheng, Hsu, Peng-Wei, Wei, Kuo-Chen, Chang, Chen-Nen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048041/
https://www.ncbi.nlm.nih.gov/pubmed/35498411
http://dx.doi.org/10.3389/fendo.2022.756855
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author Yan, Jiun-Lin
Chen, Mao-Yu
Chen, Yao-Liang
Chuang, Chi-Cheng
Hsu, Peng-Wei
Wei, Kuo-Chen
Chang, Chen-Nen
author_facet Yan, Jiun-Lin
Chen, Mao-Yu
Chen, Yao-Liang
Chuang, Chi-Cheng
Hsu, Peng-Wei
Wei, Kuo-Chen
Chang, Chen-Nen
author_sort Yan, Jiun-Lin
collection PubMed
description Acromegaly is a systemic disease that requires multidisciplinary treatment to achieve the best clinical outcome. This study aimed to evaluate the outcomes of the endoscopic transsphenoidal approach (TSA) as the primary treatment for somatotroph adenomas and further investigate patients who had suboptimal surgical results. This retrospective study included 83 patients with somatotroph adenomas treated by TSA at our institution from 1999 to 2010. Biochemical remission was defined as hGH <1 and <2.5 ng/ml. Factors associated with failure of TSA and strategy of secondary treatments for refractory and recurrent disease were analyzed. The mean age of patients was 41.1 ± 11.3 years, and the mean follow-up time was 54.2 ± 44.3 months. Approximately 44.5% of patients had residual tumors after TSA. Larger tumor size, higher GH level before the operation, and the existence of residual tumors were associated with TSA failure. Forty-one patients had an inadequate response to TSA or a recurrent lesion, and of these patients, 37 had residual tumor after TSA. Octreotide results in good outcomes in the treatment of DGSA patients, and SRS/EXRT generates good results in treating patients who receive second treatments when remission cannot be reached 6 months after TSA operation.
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spelling pubmed-90480412022-04-29 Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure Yan, Jiun-Lin Chen, Mao-Yu Chen, Yao-Liang Chuang, Chi-Cheng Hsu, Peng-Wei Wei, Kuo-Chen Chang, Chen-Nen Front Endocrinol (Lausanne) Endocrinology Acromegaly is a systemic disease that requires multidisciplinary treatment to achieve the best clinical outcome. This study aimed to evaluate the outcomes of the endoscopic transsphenoidal approach (TSA) as the primary treatment for somatotroph adenomas and further investigate patients who had suboptimal surgical results. This retrospective study included 83 patients with somatotroph adenomas treated by TSA at our institution from 1999 to 2010. Biochemical remission was defined as hGH <1 and <2.5 ng/ml. Factors associated with failure of TSA and strategy of secondary treatments for refractory and recurrent disease were analyzed. The mean age of patients was 41.1 ± 11.3 years, and the mean follow-up time was 54.2 ± 44.3 months. Approximately 44.5% of patients had residual tumors after TSA. Larger tumor size, higher GH level before the operation, and the existence of residual tumors were associated with TSA failure. Forty-one patients had an inadequate response to TSA or a recurrent lesion, and of these patients, 37 had residual tumor after TSA. Octreotide results in good outcomes in the treatment of DGSA patients, and SRS/EXRT generates good results in treating patients who receive second treatments when remission cannot be reached 6 months after TSA operation. Frontiers Media S.A. 2022-04-14 /pmc/articles/PMC9048041/ /pubmed/35498411 http://dx.doi.org/10.3389/fendo.2022.756855 Text en Copyright © 2022 Yan, Chen, Chen, Chuang, Hsu, Wei and Chang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Yan, Jiun-Lin
Chen, Mao-Yu
Chen, Yao-Liang
Chuang, Chi-Cheng
Hsu, Peng-Wei
Wei, Kuo-Chen
Chang, Chen-Nen
Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure
title Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure
title_full Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure
title_fullStr Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure
title_full_unstemmed Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure
title_short Surgical Outcome and Evaluation of Strategies in the Management of Growth Hormone-Secreting Pituitary Adenomas After Initial Transsphenoidal Pituitary Adenectomy Failure
title_sort surgical outcome and evaluation of strategies in the management of growth hormone-secreting pituitary adenomas after initial transsphenoidal pituitary adenectomy failure
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048041/
https://www.ncbi.nlm.nih.gov/pubmed/35498411
http://dx.doi.org/10.3389/fendo.2022.756855
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