J Korean Neurosurg Soc.  2014 Nov;56(5):405-409. 10.3340/jkns.2014.56.5.405.

Outcome of Endoscopic Transsphenoidal Surgery in Combination with Somatostatin Analogues in Patients with Growth Hormone Producing Pituitary Adenoma

• Zhou T
• Wang F
• Meng X
• Ba J
• Wei S
• Xu B

• KMID: 2018099
• DOI: http://doi.org/10.3340/jkns.2014.56.5.405

Abstract

OBJECTIVE
To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor.
METHODS
We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated.
RESULTS
A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery.
CONCLUSION
Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.

Keyword

GH producing pituitary adenoma; Endoscopic transsphenoidal surgery; Somatostatin analogue

MeSH Terms

Blood Glucose
Follow-Up Studies
Glucose
Growth Hormone*
Heart Ventricles
Humans
Mortality
Pituitary Neoplasms*
Retrospective Studies
Somatostatin*
Blood Glucose
Glucose
Growth Hormone
Somatostatin

Figure

• 

  Fig. 1 Pituitary MRI before and after treatment. A : Case 1. 28 yr, female, before surgery GH >40 µg/L, after surgery GH 0.40 µg/L. B : Case 2. 34 yr, male, Albright Syndrome, tumor was surrounded fibrous dysplasia of bone, before surgery GH >40 µg/L, after surgery GH 0.72 µg/L. C : Case 3. 16 yr, male, July 15, 2011, before craniotomy surgery, tumor located at suprasellar and intrasellar, extending to skull base, GH >40 µg/L; October 17, 2011, before trans-sphenoidal surgery, the residual tumor located at right intrasellar and pressed on right cavernous sinus, GH >40 µg/L; follow-up in 2013, no residual tumor supersellar and intrasellar, GH >40 µg/L. Then after treatment with long acting SSA for one year, the patient showed normal GH and improved symptoms including headache. GH : growth hormone, SSA : somatostatin analogue.

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