Investigation of the Pituitary Functions of Patients with Acromegaly Treated by Transsphenoidal Route: A Retrospective Analysis of 39 Cases

Abstract

ABSTRACT

In this study we analyzed the pituitary functions of 39 patients with acromegaly (22 male, 17 female; age (X±SD), 38±11 years; range, 16-64 years) treated by the transsphenoidal route between 1982-1996. Thirty-three patients had macroadenomas and 6 had microadenomas. The mean follow-up after surgery was 35±25 months (range:1-117 months). In 17 (43.6%) patients, there was complete remission after transsphenoidal surgery. Adjunctive radiation therapy was administered to 17 of 22 patients who did not experience a remission after surgery alone. An additional four of these were in remission by the end of the follow-up period. So the ratio of remission after surgery + radiation therapy was 21 in 39 (53.8%). The diagnosis of hypopituitarism was established according to clinical grounds and basal hormone levels in most of the patients. Eighteen of the 39 patients (46.2%) received no replacement therapy. Ten patients with panhypopituitarism received full replacement therapy. The most frequent replacement therapy was that of sex hormones (17 patients - 43.6%), the second one was glucocorticoid (14 patients - 36.8%) and the last one was thyroid hormone replacement therapy (13 patients - 34.2%). Permanent diabetes insipitus was seen in only two patients (5.1%). Relationships between the frequency of the replacement therapy and gender, tumor size, adjuvant radiotherapy, cure ratio, age, preoperative GH and prolactin levels and duration of the follow-up period are evaluated. There was a significant relationship between basal GH levels and frequency of glucocorticoid and thyroid hormone replacement therapy (p<0.05).