The outcome of surgery for acromegaly: the need for a specialist pituitary surgeon for all types of growth hormone (GH) secreting adenoma

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Abstract
OBJECTIVE: Acromegaly is associated with reduced life expectancy, while therapeutic ‘cure’ (defined by achievement of GH levels 30 mU/l before surgery, only 27 (51.9%) had GH levels below 30 mU/l post‐operatively (81.8% of microadenomas, 43.2% of macroadenomas).CONCLUSION: In comparison with other series, the cure rate in this study is significantly lower. The success in reducing GH levels below 30 mU/l post‐operatively is difficult to compare with previously published studies, as few groups have analysed their data in this manner. Nonetheless, of our acromegalic patients with a pretreatment GH level in excess of 30 mU/l, nearly 50% have similar GH status postoperatively, thereby rendering them less amenable to cure by alternative therapeutic modalities. This highlights the importance of a specialist pituitary surgeon, not only for GH secreting microadenomas but also for GH secreting macroadenomas. If these patients are not ‘cured’, the cost of continuing therapy becomes a significant burden on health‐care costs. In addition, if the postoperative GH levels remain above 30 mU/l the chances of achieving adequate control of GH levels are greatly reduced, thereby increasing mortality rates as well as morbidity in these patients.

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