Transsphenoidal surgery for growth hormone-secreting pituitary adenomas in 130 patients.

OBJECTIVE: Transsphenoid surgery is the treatment of choice for growth hormone (GH)-producing pituitary adenomas. The measures that may predict postoperative remission need to be elucidated.

METHODS: Transsphenoid surgery was performed in 163 patients by a single neurosurgeon from 1992 until 2010. Thirty-three patients were lost to follow-up, and the results of the remaining 130 are presented here.

RESULTS: A total of 81.5% of patients obtained a first postoperative day GH level less than 5 μg/L, whereas 60.5% achieved a value less than 2.5 μg/L. A total of 56.9% had achieved both a GH less than 2.5 μg/L and normal insulin-like growth factor I (IGF-I) on delayed follow-up and could be regarded as in remission. Duration of symptoms before surgery, age, preoperative GH, and IGF-I levels did not significantly influence a patient's remission. Analysis showed that cavernous sinus extension and larger tumor size were associated with decreased remission rate, whereas sellar floor invasion or suprasellar extension did not significantly influence remission.

CONCLUSION: The results of our study show that transsphenoid surgery is an optimal treatment modality for GH-secreting pituitary adenoma. Suprasellar or sellar floor invasion, and preoperative GH or IGF-I do not necessarily predict poor outcomes. Large tumor size and cavernous sinus extension contribute to greater recurrence rates.