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01-10-2020 | Acromegaly

Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review

Authors: Nidhi Agrawal, Adriana G. Ioachimescu

Published in: Pituitary | Issue 5/2020

Abstract

Purpose

Biochemical control is the main determinant of survival, clinical manifestations and comorbidities in acromegaly. Transsphenoidal selective adenomectomy (TSA) is the initial treatment of choice with reported biochemical remission rates varying between 32 and 85%. Understanding the limiting factors is essential for identification of patients who require medical treatment.

Methods

We reviewed the English literature published in Medline/Pubmed until Dec 31, 2019 to identify eligible studies that described outcomes of TSA as primary therapy and performed analyses to determine the main predictors of remission.

Results

Most publications reported single-institution, retrospective studies. The following preoperative parameters were consistently associated with lower remission rates: cavernous sinus invasion by imaging, larger tumor size and higher GH levels. Young age and preoperative IGF-1 levels were predictive in some studies. When controlled for covariates, the best single preoperative predictor was cavernous sinus invasion, followed by preoperative GH levels. Conversely, low GH level in the first few days postoperatively was a robust predictor of durable remission. The influence of tumor histology (sparsely granular pattern, co-expression of prolactin and proliferation markers) on surgical remission remains to be established. Few studies developed predictive models that yielded much higher predictive values than individual parameters.

Conclusion

Surgical outcome prognostication systems could be further generated by machine learning algorithms in order to support development and implementation of personalized care in patients with acromegaly.

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Title: Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review
Authors: Nidhi Agrawal
Adriana G. Ioachimescu
Publication date: 01-10-2020
Publisher: Springer US
Keyword: Acromegaly
Published in: Pituitary / Issue 5/2020
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-020-01063-x

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Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review

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Conclusion

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