Recurrence in acromegaly: two tertiary centers experience and review of the literature

IF 3.9 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Journal of Endocrinological Investigation Pub Date : 2024-03-19 DOI:10.1007/s40618-024-02321-6

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Abstract

Background

Recurrence of acromegaly after successful surgery is a rare event, but no clear data are reported in the literature about its recurrence rates. This study aimed to evaluate the recurrence rate in a series of acromegalic patients treated by transsphenoidal surgery (TSS) with a long follow-up.

Methods

We retrospectively analyzed data from 283 acromegalic patients who underwent TSS at two pituitary units in Milan (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and IRCCS Humanitas Research Hospital). The diagnosis and recurrence of acromegaly were defined by both elevated IGF-1 levels and a lack of GH suppression based on appropriate criteria for the assay used at the time of diagnosis.

Results

After surgery, 143 patients (50%) were defined as not cured, 132 (47%) as cured and 8 (3%) as partially cured because of normalization of only one parameter, either IGF1 or GH. In the cured group, at the last follow-up (median time 86.8 months after surgery), only 1 patient (0.7%) showed full recurrence (IGF-1 + 5.61 SDS, GH nadir 1.27 µg/l), while 4 patients (3%) showed only increased IGF1. In the partially cured group at the last follow-up, 2/8 (25%) patients showed active acromegaly (IGF-1 SDS + 2.75 and + 3.62; GH nadir 0.6 and 0.5 µg/l, respectively).

Conclusions

In the literature, recurrence rates range widely, from 0 to 18%. In our series, recurrence occurred in 3.7% of patients, and in fewer than 1%, recurrence occurred with elevation of both IGF-1 and the GH nadir. More frequently (25%), recurrence came in the form of incomplete normalization of either IGF-1 or GH after surgery.

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肢端肥大症复发：两家三级医疗中心的经验和文献综述

摘要背景手术成功后肢端肥大症复发是一种罕见的情况，但文献中没有关于其复发率的明确数据。本研究旨在评估一系列接受经蝶鞍手术（TSS）治疗并长期随访的肢端肥大症患者的复发率。方法我们回顾性分析了在米兰两家垂体科医院（Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico 和 IRCCS Humanitas 研究医院）接受经蝶窦手术治疗的 283 例渐冻人症患者的数据。肢端肥大症的诊断和复发以 IGF-1 水平升高和缺乏 GH 抑制为标准，以诊断时使用的检测方法为依据。结果手术后，143 名患者（50%）被定义为未痊愈，132 名（47%）被定义为痊愈，8 名（3%）被定义为部分痊愈，因为只有一项参数（IGF1 或 GH）恢复正常。在治愈组中，最后一次随访（术后中位时间为 86.8 个月）时，只有 1 名患者（0.7%）显示完全复发（IGF-1 + 5.61 SDS，GH 最低值为 1.27 µg/l），而 4 名患者（3%）仅显示 IGF1 增高。在最后一次随访的部分治愈组中，2/8（25%）名患者出现活动性肢端肥大症（IGF-1 SDS + 2.75 和 + 3.62；GH 最低值分别为 0.6 和 0.5 µg/l）。结论在文献中，复发率的范围很广，从 0% 到 18%。在我们的系列研究中，3.7%的患者复发，而在 IGF-1 和 GH 最低值均升高的情况下复发的患者不到 1%。更常见的情况（25%）是术后 IGF-1 或 GH 未完全恢复正常而复发。

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来源期刊

Journal of Endocrinological Investigation 医学-内分泌学与代谢

CiteScore

8.70

自引率

7.40%

发文量

242

审稿时长

3 months

期刊介绍： The Journal of Endocrinological Investigation is a well-established, e-only endocrine journal founded 36 years ago in 1978. It is the official journal of the Italian Society of Endocrinology (SIE), established in 1964. Other Italian societies in the endocrinology and metabolism field are affiliated to the journal: Italian Society of Andrology and Sexual Medicine, Italian Society of Obesity, Italian Society of Pediatric Endocrinology and Diabetology, Clinical Endocrinologists’ Association, Thyroid Association, Endocrine Surgical Units Association, Italian Society of Pharmacology.