J Neurol Surg B Skull Base 2022; 83(S 01): S1-S270
DOI: 10.1055/s-0042-1743684
Presentation Abstracts
Podium Abstracts

Intraoperative Growth Hormone for Prediction of Long-Term Outcome after Surgery for Acromegaly

Authors

  • Marcus Zachariah

    1   University of Mississippi Medical Center, Jackson, Mississippi, United States

  • Jordan Bozer

    1   University of Mississippi Medical Center, Jackson, Mississippi, United States

  • Abdulaziz Alrasheed

    2   King Saud Medical City, Riyadh, Saudi Arabia

  • Luma Ghalib

    3   Ohio State University, Columbus, Ohio, United States

  • Ricardo Carrau

    3   Ohio State University, Columbus, Ohio, United States

  • Daniel Prevedello

    3   Ohio State University, Columbus, Ohio, United States
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    Objective: Acromegaly presents the pituitary neurosurgeon with a challenge as the features associated with long-term remission are incompletely understood. An intraoperative predictor for long-term outcome would be valuable for assessing resection of growth hormone (GH) secreting tumors in real time. In this study, we sought to evaluate whether intraoperative GH measurement could predict long-term outcome after surgery for acromegaly.

    Methods: In 45 patients, GH levels were measured from peripheral blood thrice intraoperatively: once prior to tumor dissection, once during tumor dissection, and once after tumor dissection was complete. Long-term remission was defined by most recent insulin-like growth factor-1 (IGF-1) in the age and sex-adjusted normal range without need for postoperative medication or radiation treatment.

    Results: Average length of follow up was 3.25 years (±2.10). Long-term remission was achieved in 55.6% (25/45) of operations. Excluding tumors with cavernous sinus invasion, the long-term remission rate was 77.8% (21/27). Similar to prior studies, cavernous sinus invasion (odds ratio [OR]: 0.082; 95% confidence interval [CI]: 0.020–0.343; p = 0.0002), suprasellar extension (OR: 0.314; 95% CI: 0.092–1.071; p = 0.060), and resection technique (OR: 0.167; 95% CI: 0.032–0.882; p = 0.023) were all less associated with long-term remission. The minimum GH level measured intraoperatively predicted long-term outcome (area under the curve (AUC) = 0.682; 95% CI: 0.510–0.855; p = 0.009). The odds ratio of remission in patients with the lowest quartile minimum intraoperative GH compared to patients with the highest quartile minimum intraoperative GH was 6.0 (95% CI: 1.018–35.374; p = 0.041).

    Conclusion: Intraoperative GH may predict long-term outcome after surgery for acromegaly. Further study of intraoperative testing to predict long-term outcome in acromegaly and other hormone-secreting pituitary tumors may be necessary.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    15 February 2022

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