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Akromegali Hastalarındaki Tedavi Sonuçlarımız

Therapeutic Results Of Our Acromegalic Patients

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2003

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
We aimed to evaluate our therapy results in acromegalic patients for last ten years. Although 52 acromegalic patients admitted to our center, only 30 (M/F: 13/17) patients whose follow-up data were available enrolled into the study. Their mean age was 43 ± 38 (28-64) years, mean age of diagnosis was 39 ± 9 (26-60) years and mean follow-up period was 42 ± 38 (5-127) months. Basal or nadir postglucose GH level less than 2 ng/ml accepted as cure criteria. After diagnosis, all patients operated transsphenoidally in different medical centers by different surgeons and the cure rate of first operation was 33 % (10/30). The cure rates were 63 % and 15 % in patients with microadenomas (n=11) and macroadenomas (n=19) respectively. And the difference was statistically significant (p<0.05). Four of 11 patients with unsuccessful surgery were cured with radiotherapy and hypopituitarism occurred in 2 of them. GH levels could not be suppressed below 2 ng/ml even 30 mg/month dose, in only one (8 %) of 11 patients treated with octreotide-LAR. While the cure has established in 1 (16 %) of reoperated 6 cases, postoperative hypopituitarism was observed in 5 (83 %) of them. Although there was no meaningful difference in the cure rates between first and second operation, the risk of hypopituitarism was significantly higher in reoperated patients (p=0.008). In conclusion cure rate probability was found higher in patients with microadenomas after transsphenoidal operation while it was very low in patients with macroadenomas. Our low cure rates could be attributed to the fact that the operations have been performed by inexperienced surgeons. While cure probability decreases after the second operation, complication risk increases. Octreotide therapy, which could be used as an alternative choice to the surgery, revealed high success rates in microadenomas and macroadenomas.
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Abstract (Original Language): 
Akromegali tanılı hastaların 10 yıllık süre içinde merkezimizdeki tedavi sonuçlarını değerlendirmeyi amaçladık. Merkezimize başvuran toplam 52 akromegali hastası olmasına karşın klinik izlem bilgilerine ulaşılabilen 30 hasta (E/K: 13/17) çalışmaya alındı. Yaş ortalamaları 43 ± 10 (28-64) yıl, akromegali tanısı aldıklarındaki yaş ortalamaları 39 ± 9 (26-60) yıl ve ortalama izlem süreleri 42 ± 38 (5-127) ay idi. Kür olma kriteri serum GH seviyesinin bazal veya glukoz yüklemesi sonrası 2 ng/ml altına inmesi olarak kabul edildi. Tanı sonrası tüm hastaların değişik merkezlerde ve değişik cerrahlar tarafından transsfenoidal hipofizektomi operasyonu geçirdiği ve birinci operasyonda % 33 (10/30) oranında kür elde edildiği görüldü. Operasyon öncesi mikroadenomu olan hastalardaki (n=11) kür oranı % 63, makroadenomu olan hastalardaki (n=19) kür oranı % 15 idi. Aralarındaki fark istatistiksel olarak anlamlı bulundu (p<0.05). Postoperatif kür olmayan hastalarda uygulanan radyoterapi sonrası 11 olgunun ancak 4’ünde kür elde edilirken, bunların 2’sinde hipopitüitarizm geliştiği görüldü. Oktreotid-LAR tedavisi uygulanan 12 hastanın sadece 1’inde (% 8) 30 mg/ay dozuna rağmen GH seviyesinin 2 ng/ml altına indirilemediği görüldü. İkinci kez operasyon uygulanan 6 hastanın yalnızca 1 tanesinde (% 16) kür elde edilebilirken, beşinde (%83) operasyona sekonder hipopitüitarizm geliştiği görüldü. Birinci operasyon ile karşılaştırıldığında kür başarısı yönünden anlamlı farklılık saptanmaz iken, hipopitüitarizm gelişme riski anlamlı yüksek bulundu (p=0.008). Sonuç olarak mikroadenomu olan hastalarda transsfenoidal operasyon sonrası kür olasılığı yüksek iken makroadenomlularda bu olasılık çok düşük bulundu. Bizim elde ettiğimiz kür oranlarının yayınlardan daha düşük olmasının nedeni operasyonların tecrübeli sayılabilecek cerrahlar tarafından yapılmamış olmasına bağlandı. İkinci operasyon sonrasında kür elde etme olasılığı çok daha azalırken, komplikasyon görülme olasılığının arttığı görüldü. Makroadenom ve mikroadenomlularda uygulanan oktreotid tedavisinin büyüme hormonu seviyesini güvenli sayılan seviyelere baskıladığı ve operasyona seçenek olabileceği saptandı.
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  • 3
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  • Turkish

REFERENCES

References: 

1. Melmed S, Jackson I, Kleinberg D, Klibanski A. Current
treatment guidelines for acromegaly. J Clin Endocrinol Metab
1998;83(8):2646-52.
2. Holdaway IM, Rajasoorya CR, Gamble GD, Stewart AW.
Long-term treatment outcome in acromegaly. Growth Horm
IGF Res 2003;13(4):185-92.
3. Sheaves R, Jenkins P, Blackburn P, Huneidi AH, Afshar F,
Medbak S, Grossman AB, Besser GM, Wass JA. Outcome of
transsphenoidal surgery for acromegaly using strict criteria for
surgical cure. Clin Endocrinol (Oxf) 1996;45(4):407-13.
4. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for
growth hormone-secreting pituitary adenomas:initial outcome
and long-term results. J Clin Endocrinol Metab
1998;83(10):3409-10.
5. Lissett CA, Peacey SR, Laing I, Tetlow L, Davis JR, Shalet
SM. The outcome of surgery for acromegaly: the need for a
specialist pituitary surgeon for all types of growth hormone
(GH) secreting adenoma. Clin Endocrinol (Oxf)
1998;49(5):653-7.
6. Swearingen B, Barker FG 2nd, Katznelson L, Biller BM,
Grinspoon S, Klibanski A, Moayeri N, Black PM, Zervas NT.
Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly. J Clin Endocrinol Metab
1998;83(10):3409-10.
7. Ahmed S, Elsheikh M, Stratton IM, Page RC, Adams CB,
Wass JA. Outcome of transphenoidal surgery for acromegaly
and its relationship to surgical experience. Clin Endocrinol
(Oxf) 1999;50(5):561-7.
8. Fahlbusch R, Honegger J, Buchfelder M. Evidence supporting
surgery as treatment of choice for acromegaly. J Endocrinol
1997;155 Suppl 1:S53-5.
9. Shimon I, Cohen ZR, Ram Z, Hadani M. Transsphenoidal
surgery for acromegaly: endocrinological follow-up of 98 patients. Neurosurgery 2001;48(6):1239-43.
10. Gittoes NJ, Sheppard MC, Johnson AP, Stewart PM. Outcome
of surgery for acromegaly--the experience of a dedicated pituitary surgeon. QJM 1999;92(12):741-5.
11. Clayton RN. How many surgeons to operate on acromegalic
patients? Clin Endocrinol (Oxf) 1999;50(5):557-9.
12. Attanasio R, Epaminonda P, Motti E, Giugni E, Ventrella L,
Cozzi R, Farabola M, Loli P, Beck-Peccoz P, Arosio M.
Gamma-knife radiosurgery in acromegaly: a 4-year follow-up
study. J Clin Endocrinol Metab 2003;88(7):3105-12.
13. Colao A, Ferone D, Marzullo P, Cappabianca P, Cirillo S,
Boerlin V, Lancranjan I, Lombardi G. Long-term effects of
depot long-acting somatostatin analog octreotide on hormone
levels and tumor mass in acromegaly. J Clin Endocrinol Metab 2001;86(6):2779-86.
14. Cozzi R, Attanasio R, Montini M, Pagani G, Lasio G, Lodrini
S, Barausse M,Albizzi M, Dallabonzana D, Pedroncelli AM.
Four-year treatment with octreotide-long-acting repeatable in
110 acromegalic patients: predictive value of short-term results? J Clin Endocrinol Metab 2003;88(7):3090-8. Akromegali Sonuçlarımız
45
15. Davis DH, Laws ER Jr, Ilstrup DM, Speed JK, Caruso M,
Shaw EG, Abboud CF,Scheithauer BW, Root LM, Schleck C.
Results of surgical treatment for growth hormone-secreting pituitary adenomas. J Neurosurg 1993;79(1):70-5.
16. Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: a retrospective cohort
study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab 1998;83(8):2730-4.
17. Bates AS, Van't Hoff W, Jones JM, Clayton RN. An audit of
outcome of treatment in acromegaly. Q J Med
1993;86(5):293-9.
18. Holdaway IM, Rajasoorya C. Epidemiology of acromegaly.
Pituitary 1999;2(1):29-41.
19. Long H, Beauregard H, Somma M, Comtois R, Serri O, Hardy
J. Surgical outcome after repeated transsphenoidal surgery in
acromegaly. J Neurosurg 1996;85(2):239-47.
20. Abe T, Ludecke DK. Recent results of secondary transnasal
surgery for residual or recurring acromegaly. Neurosurgery
1998;42(5):1013-21.
21. Biermasz NR, Dulken HV, Roelfsema F. Postoperative radiotherapy in acromegaly is effective in reducing GH concentration to safe levels. Clin Endocrinol (Oxf) 2000;53(3):321-7.
22. Barrande G, Pittino-Lungo M, Coste J, Ponvert D, Bertagna
X, Luton JP, Bertherat J. Hormonal and metabolic effects of
radiotherapy in acromegaly: long-term results in 128 patients
followed in a single center. J Clin Endocrinol Metab
2000;85(10):3779-85.
23. Newman CB, Melmed S, George A, Torigian D, Duhaney M,
Snyder P, Young W,Klibanski A, Molitch ME, Gagel R,
Sheeler L, Cook D, Malarkey W, Jackson I,Vance ML, Barkan A, Frohman L, Kleinberg DL. Octreotide as primary therapy for acromegaly. J Clin Endocrinol Metab
1998;83(9):3031-3.
24. Bevan JS, Atkin SL, Atkinson AB, Bouloux PM, Hanna F,
Harris PE, James RA,McConnell M, Roberts GA, Scanlon
MF, Stewart PM, Teasdale E, Turner HE, Wass JA, Wardlaw
JM. Primary medical therapy for acromegaly: an open, prospective, multicenter study of the effects of subcutaneous and
intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size. J Clin Endocrinol
Metab 2002;87(10):4554-63.
25. Biermasz NR, van Dulken H, Roelfsema F. Ten-year followup results of transsphenoidal microsurgery in acromegaly.J
Clin Endocrinol Metab 2000;85(12):4596-602.

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