Surgery for Acromegaly: the Outcome Based on Stringent Criteria of Remission

Acromegaly is a rare disease with increased mor-tality rate. present literature documents the treatment of choice for acromegaly is surgery, curative in 91% of pituitary microadenomas and up to 73% of macroadenomas. the aim of this study was to present our experience in the diag-nosis and treatment of a series of patients suffer-ing from acromegaly, and to compare the results concerning control of disease with other series using modern criteria for therapy. materials and methods: of fifty patients (31 men, 19 women) referring to the mashhad endo-crine out-patient clinic between 2001 and 2005, diagnosed with acrimegaly. 40 underwent sur-gery as initial therapy. we used a combination of modern, evidence-based remission criteria in-cluding basal gh below 2.5 µg/l (5 mu/l), a na-dir gh below than 1.0 µg/l (2 mu/l) after an oral glucose tolerance test, and normal age-related igf-i levels 6 months after surgery for the definition of cure in our patients. results: fifteen of the 40 patients operated (37.5%) remained in remission after just transsphenoidal surgery; 80% of patients with microadenomas but only 31.4% of patients with macroadenomas achieved remission; 50% intrasellar macroade-nomas showed remission, compared with only 21.7% extrasellar extended macroadenomas. the rate of biochemical ‘cure’ correlated with the magnitude of the initial gh levels, the tumor size and invasion. conclusion: in conclusion, using stringent crite-ria of remission, our results compared well with similar series of microadenomas and intrasellar macroadenomas, whereas outcomes for extrasel-lar macroadenomas were less than satisfactory.