Endocrine Accompaniments in Acromegaly Patients Before and After Surgery

Authors

  • SABA KHALID Department of Physiology and Cell Biology, University of Health Sciences, Lahore
  • KHALID MAHMOOD Department of Physiology and Cell Biology, University of Health Sciences, Lahore
  • TARIQ SALAHUDDIN Department of Physiology and Cell Biology, University of Health Sciences, Lahore

Keywords:

Acromegaly, Insulin-like growth factor I,, Pituitary adenoma, Surgical outcome

Abstract

Background and Aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH – secreting adenomas. The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral adenohypophyseal hormones. In addition, the pituitary hormones have also been measured directly in the adenoma tissue following its surgical removal.
Methods: The present study is based on 07 patients (04 males and 3 females), 30-50 year of age, diagnosed for Functional Pituitary Adenomas (FPAs) on the basis of clinical and radiological evidence. An equal number of age matched healthy subjects were included as controls. Follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), growth hormone (GH) and prolactin (PRL) were determined in serum before and following trans-sphenoidal adenomectomy. The GH, FSH, TSH and PRL content of the excised adenoma tissue was also measured in male patients. All hormone determinations were carried out using commercially available immuno-assay kits (ELISA and IRMA) in duplicate.
Results: The results demonstrate that the mean serum GH levels in the 04 male and 03 female patients with FPAs were found to be significantly higher before surgical removal as compared to those obtained following surgery. Significant differences were observed between pre- and postsurgical serum GH levels in male and female patients with FPA. GH content was also determined in the male adenoma tissue. Following removal of the adenoma in these 4 male and 03 female patients, peripheral serum GH levels fell within the normal range. The adenoma tissue GH content in patients with initial higher serum GH levels was also significantly greater than that of the other patients. The mean serum PRL concentration in male patients before removal of the adenoma and values obtained after surgical removal of the adenoma and those of control subjects were not significantly different. The mean PRL concentration of the adenoma tissue in all the male patients was not significantly different from the control pituitary tissue. However, the presurgical mean serum PRL concentration were significantly higher in 2 of the 3 female patients included in this study as compared to the control values. Following removal of adenoma, normal serum levels were attained in those patients. In the remaining one female patient serum PRL concentra-tion was within the normal range before and following surgical removal of the adenoma. The mean serum FSH levels in the 04 male patients with FPAs were not significantly different before and after surgical removal of ade-noma tissue. However, an examination of individual values reveals higher FSH levels in 02 of the male patients and in 01 of the three premenopausal female patients. Following surgical removal of the adenoma, serum FSH concentrations showed a marked decline of FSH levels in those patients. However, the remaining two females showed normal FSH levels before and after surgery. The adenoma FSH content of these patients was not signifi-cantly higher than those of the control pituitary tissue. No significant differences were observed between pre and post-surgical serum TSH levels. The TSH content of adenoma tissue was either non-detectable or in the low range as compared to the TSH content determined in control pooled pituitary tissue.
Conclusion: Transsphenoidal surgery is thought to be an effective primary treatment for GH-secreting pituitary adenomas according to the most recent criteria of cure. Because the remission rate in cases with cavernous sinus
Endocrine Accompaniments in Acromegaly Patients Before and After Surgery invasion is very low, early detection of the tumor before it extends into the cavernous sinus and a long-term endocrinological and radiological follow-up are necessary in order to improve the remission rate of acromegaly.

References

1. Abbassioun K, Amirjamshidi M, Mehrazin A, Khalat-bary I, Keynama M, Bokai H, et al: A prospective ana-lysis of 151 cases of patients with acromegaly operated by one neurosurgeon: a follow-up more than 23 years. Surg Neurol 2006; 66: 26-31; discussion 31.
2. Beauregard C, Truong U, Hardy J, Serri O: Long – term outcome and mortality after transsphenoidal adeno-mectomy for acromegaly. Clin Endocrinol (Oxf) 2003; 58: 86-91.
3. Bolanowski M, Zatonska K, Kaluzny M, Zielinski G, Bednarek – Tupikowska G, Bohdanowicz-Pawlak A, et al: A follow-up of 130 patients with acromegaly in a single centre. Neuro Endocrinol Lett 2006; 27: 828-832.
4. Bush ZM, Vance ML: Management of acromegaly: is there a role for primary medical therapy? Rev Endocr Metab Disord 2008; 9: 83-94.
5. Carmichael JD, Bonert VS: Medical therapy: options and uses. Rev Endocr Metab Disord 2008; 9: 71-81.
6. Costa AC, Rossi A, Martinelli CE Jr, Machado HR, Moreira AC: Assessment of disease activity in treated acromegalic patients using a sensitive GH assay: should we achieve strict normal GH levels for a biochemical cure? J Clin Endocrinol Metab 2002; 87: 3142-3147.
7. De P, Rees DA, Davies N, John R, Neal J, Mills RG, et al: Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab 2003; 88: 3567-3572.
8. Eastman RC, Gorden P, Glatstein E, Roth J: Radiation therapy of acromegaly. Endocrinol Metab Clin North Am 1992; 21: 693-712.
9. Fukuoka S, Ito T, Takanashi M, Hojo A, Nakamura H: Gamma knife radiosurgery for growth hormone-secre-ting pituitary adenomas invading the cavernous sinus. Stereotact Funct Neurosurg 2001; 76: 213-217.
10. Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K, et al: Criteria for cure of acrome-galy: a consensus statement. JClin Endocrinol Metab 2000; 85: 526-529.
11. Goffman TE, Dewan R, Arakaki R, Gorden P, Oldfield EH, Glatstein E: Persistent or recurrent acromegaly. Long – term endocrinologic efficacy and neurologic safety of postsurgical radiation therapy. Cancer 1992; 69: 271-275.
12. Isono M, Inoue R, Kamida T, Kobayashi H, Matsuyama J: Significance of leptin expression in invasive potential of pituitary adenomas. Clin Neurol Neurosurg 2003; 105: 111-116.
13. Kawamoto H, Uozumi T, Kawamoto K, Arita K, Yano T, Hirohata T: Analysis of the growth rate and caver-nous sinus invasion of pituitary adenomas. Acta Neuro-chir (Wien) 1995; 136: 37-43.
14. Kim IM, Yim MB, Lee CY: The outcome of transsphe-noidal microsurgery for acromegaly. J Korean Neuro-surg Soc 2002; 32: 131-135.
15. Knosp E, Steiner E, Kitz K, Matula C: Pituitary ade-nomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33: 610-617; discussion 617-618.
16. Freda PU, Post KD, Powell JS, Wardlaw SL. Evalu-ation of disease status with sensitive measures of gro-wth hormone secretion in 60 postoperative patients with acromegaly. J Clin Endocrinol Metab 1998; 83: 3808- 3816.
17. Laws ER Jr and Thapar K. Pituitary surgery. Endocri-nology and Metabolism Clinics of North America 1999; 28: 119–131.
18. Wilson CB. Surgical management of pituitary tumors. Journal of Clinical Endocrinology and Metabolism 1997; 82: 2381–2385.
19. Melmed S, Jackson I, Kleinberg D and Klibanski A. Current treatment guidelines for acromegaly. Journal of Clinical Endocrinology and Metabolism 1998; 83: 2646–2652.
20. Kreutzer J, Vance ML, Lopes MB and Laws ER Jr. Surgical management of GH – secreting pituitary ade-nomas: an outcome study using modern remission cri-teria. Journal of Clinical Endocrinology and Metabo-lism 2001; 86: 4072–4077.
21. Freda PU, Wardlaw SL and Post KD. Long – term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acrome-galy. Journal of Neurosurgery 1998; 89: 353–358.
22. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB and Wilson CB. Transsphenoidal micro-surgery for growth hormone secreting pituitary adeno-mas: initial outcome and long-term results. Journal of Clinical Endocrinology and Metabolism 1998; 83: 3411–3418.
23. Swearingen B, Barker FG 2nd, Katznelson L, Biller BM, Grinspoon S, Klibanski A, Moayeri N, Black PM and Zervas NT. Long – term mortality after transsphe-noidal surgery and adjunctive therapy for acromegaly. Journal of Clinical Endocrinology and Metabolism 1998; 83: 3419–3426.
24. Barrande G, Pittino-Lungo M, Coste J, Ponvert D, Ber-tagna X, Luton JP and Bertherat J. Hormonal and meta-bolic effects of radiotherapy in acromegaly: long-term results in 128 patients followed in a single center. Jour-nal of Clinical Endocrinology and Metabolism 2000; 85: 3779–3785.
25. Biermasz NR, van Dulken H and Roelfsema F. Long-term follow-up results of postoperative radiotherapy in 36 patients with acromegaly. Journal of Clinical Endo-crinology and Metabolism 2000; 85: 2476–2482.

Downloads

Published

2018-11-04

Issue

Section

Original Articles