REOPERATION VERSUS IRRADIATION IN CASES OF RECURRENT OR PERSISTENT GROWTH HORMONE SECRETING PITUITARY ADENOMA

Main Article Content

Mohamed Ahmed Eissa
Amr El Samman
Ehab El Refaee
Mostafa Mohsen
Ayman Tarek Mahmoud

Keywords

Irradiation, Recurrent growth hormone, Acromegaly, Pituitary adenoma

Abstract

Background: Acromegaly is an uncommon disorder, with a prevalence of five to six patients for every one hundred thousand populations and an incidence of three to four for every million. The third most common intracranial neoplasm is pituitary adenomas which arise from adeno   hypophysial   cells   of   the anterior pituitary gland.


 


Aims and objectives: To identify the best option for treating recurrent and persistent acromegaly and evaluate the risks and advantages of each option.


 


Patients and methods: The study was conducted on operated cases with retrospectively collected follow-up data from 11 cases admitted to the Cairo University Hospitals in the period between March 2019 and April 2020 and 13 cases from the International Medical Center Cairo, Egypt, suffering from recurrent pituitary adenomas.


 


Results: There was a significant variance in age among the two groups (P = 0.015), but there was no significant variance among the two groups concerning type of adenoma (P = 0.123), pre-intervention GH mean levels among the two groups (P = 0.325), cavernous sinus affection between the two groups (P = 1.00), or outcome (P = 0.300).


 


Conclusion: In a carefully chosen group of acromegalic patients who had undergone prior operations at our center, both gamma knife stereotactic radiotherapy and sphenoidal surgery were effective and safe. While our study outcomes favor more trans-sphenoidal surgery over gamma knife stereotactic radiotherapy due to high rates of reduction of GH, less need for post-intervention treatment, and less time for achieving remission,

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References

1. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using the current criteria of biochemical cure. Eur J Endocrinol 2005;152:379–87.
2. Baumann G. Acromegaly. Endocrinol Metab Clin 1987;16:685– 703.
3. Alexander L, Appleton D, Hall R. Epidemiology of acromegaly in the Newcastle region. Clin Endocrinol 1980;12:71–9.
4. Vasen H, Van Erpecum K, Roelfsema F, et al. Increased prevalence of colonic adenomas in patients with acromegaly. Eur J Endocrinol 1994;131:234–7
5. Katznelson L. An update on treatment strategies for acromegaly. Expert Opin Pharmacother 2008;9:2273–80.
6. Holdaway I, Rajasoorya R. Epidemiology of acromegaly. Pituitary 1999;2:29–41. Vasen H, Van Erpecum K, Roelfsema F, et al. Increased prevalence of colonic adenomas in patients with acromegaly. Eur J Endocrinol 1994;131:234–7.
7. Grunstein R, Ho K, Sullivan C. Effect of octreotide, a somatostatin analogue, on sleep apnoea in patients with acromegaly. Ann Intern Med 1994;121:478–83.
8. Matano Y, Okada T, Suzuki A, et al. Risk of colorectal neoplasm in patients with acromegaly and its relationship with serum growth hormone levels. Am J Gastroenterol 2005;100:1154–60.
9. Orme S, McNally R, Cartwright R, et al. Mortality and cancer incidence in acromegaly: a retrospective cohort study. J Clin Endocrinol Metab 1998;83:2730–4.
10. CZITO, Brian G.; FULLER, Clifton David. Radiation therapy. Biliary tract and gallbladder cancer: diagnosis & therapy. Demos, 2008, 217-35.‏
11. Serri O, Somma M, Comtois R, et al. Acromegaly: biochemical assessment of cure after long-term follow-up of transsphenoidal selective adenomectomy. J Clin Endocrinol Metab 1985;61:1185– 9.
12. BIR, Shyamal C., et al. Clinical and radiologic outcome of gamma knife radiosurgery on nonfunctioning pituitary adenomas. Journal of Neurological Surgery Part B: Skull Base, 2015, 351-357.‏
13. FREDA, Pamela U., et al. Significance of “abnormal” nadir growth hormone levels after oral glucose in postoperative patients with acromegaly in remission with normal insulin-like growth factor-I levels. The Journal of Clinical Endocrinology & Metabolism, 2004, 89.2: 495-500.‏
14. JEŽKOVÁ, Jana, et al. Gamma knife radiosurgery for acromegaly–long‐term experience. Clinical endocrinology, 2006, 64.5: 588-595.‏
15. Iwai Y, Yamanaka K, Yoshimura M, et al. Gamma knife radiosurgery for growthhormone-producing adenomas. J Clin Neurosci 2007;17:299–304.