Comparison of the Outcome of Repeat Surgery versus Medical Treatment with Somatostatin Analogue in Persistent and Recurrent Cases of Acromegaly Referred to Pituitary Clinic of Sina Hospital between 2013 and 2018

Dalfardi, S; Heydarian, Peimaneh; Karimi Yarandi, K; Shirani, M; Amirjamshidi, A

Comparison of the Outcome of Repeat Surgery versus Medical Treatment with Somatostatin Analogue in Persistent and Recurrent Cases of Acromegaly Referred to Pituitary Clinic of Sina Hospital between 2013 and 2018

Document Type : Original Article

Authors

S Dalfardi

Peimaneh Heydarian

K Karimi Yarandi

M Shirani

A Amirjamshidi

Professor of Neurosurgery, Tehran University of Medical Sciences and Health Services, Sina Hospital, Tehran, Iran

Abstract

Introduction & Objective: A lot of data exists in the literature about de novo acromegaly and the results of treatment with somatostatin analogue (SSA) and primary surgery. However, in recurrent and persistent acromegaly researches are sparse. The main subject of current study is evaluation of surgery and treatment with SSA in recurrent and persistent acromegalic patients. Materials & Methods: In this historical cohort study, the target patients were the ones referred to pituitary clinic of Sina Hospital between 2013 and 2018. Two methods of repeat surgery (as preferred option) and medical treatment with SSA were advised to patients and the treatment was finally chosen according to the patient’s will. Visual field, pituitary MRI, basal GH, IGF1, OGTT were assessed in months 3, 6 and 12 of follow-up. Finally, the rate of favorable outcome (OGTT < 1 ng/ml, without any new visual field deficit and tumor regrowth) and remission (normal GH and normal IGF1) were separately assessed. Results: Of 14 patients collected in surgical group (6 microadenomas and 8 macroadenomas) remission was achieved in 57% (8 cases) and favorable outcome was found in 64% (9 patients). In 16 patients of medical group remission was achieved in 62% (10 cases), while favorable outcome was seen in 25% (4 patients). Conclusions: It seems that in pure monohormonal non-metastatic recurrent acromegaly with a resectable and accessible mass in imaging the preferred approach can be surgery. In high risk patients and in cases who prefer medical therapy or cases with unresectable mass medical treatment with SSA can be advised.

Keywords

Acromegaly

Somatostatin Analogue

Repeat surgery

Adenoma

Pituitary