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

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 mu g/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 6.7135.4 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.