Growth Hormone Secreting Adenomas: Early Endocrinal Remission and Extent of Resection Following Transsphenoidal Surgery

Background: Achieving endocrinal remission is technically challenging in growth hormone (GH) secreting adenomas. Transsphenoidal surgery represents the primary treatment option for these tumors. Objective: The aim of the study was to assess clinical outcome, early endocrinal remission and extent of resection in patients with GH secreting adenomas operated upon by transsphenoidal approach. Patients Methods: The study retrospectively included fifteen patients with GH secreting adenomas operated upon by transssphenoidal approach. Laboratory diagnosis was based on elevated GH and/or elevated insulin-like growth factor (IGF-1). Early postoperative basal GH less than 2.5 ng/mL was enough to establish endocrinal remission. If basal GH level was 2.5-5 ng/mL, endocrinal remission was confirmed by either normalized IGF-1 to age and sex and/or total resection on postoperative magnetic resonance imaging (MRI) performed after 3 months. Results: Visual improvement occurred in 85.7% of patients presenting with visual affection. Endocrinal remission was achieved in 53.3% of patients. Gross total resection was achieved in 66.6% of cases. Cavernous sinus invasion was the main limitation for endocrinal remission and total resection. There was no mortality or major morbidity. Permanent diabetes insipidus occurred in one patient and there was no postoperative cerebrospinal fluid leak or meningitis. Conclusion: Transsphenoidal surgery represents an important tool in management of GH secreting adenomas. High rates of endocrinal remission and gross total resection can be achieved in patients with smaller noninvasive tumors. Tumors with cavernous sinus extension require multimodal treatment with the transsphenoidal approach being a corner stone of this multimodal treatment.