一般演題 0537(11)
Recent primary transnasal surgical outcome associated with intraoperative growth hormone measurement in acromegaly: Takumi ABE, Kiyoshi MATSUMOTO and Dieter K. LUECKE* (Dept. of Neurosurgery, Showa Univ. School of Medicine, and *Hamburg Univ., Hamburg, Germany)
OBJECTIVE: Since 1983, we have measured growth hormone (GH) intraoperatively to improve the surgical outcome of acromegalic patients with GH secreting pituitary adenomas. This paper presents the recent results of primary surgery in patients with acromegaly to examine the effect of improved surgical techniques and experience. METHODS: The intraoperative GH was measured in 78 consecutive acromegalic patients who had not previously undergone surgery from May 1992 to April 1994 (F/M=45/33, age range, 21 to 70 yrs, mean, 47 yrs). All patients were followed for at least 3 years. Direct transnasal tumor extirpation was performed. Intraoperative GH measurements were assayed 0, 20, and 60 minutes after tumor removal. A plasma GH level > 4.5 ug/L at 60 minutes after initial tumor removal was defined as a sufficient decline (SD). In cases with intraoperative plasma GH concentrations > 40 ug/L prior to tumor resection, the half-life of the GH concentration at 20 minutes was used to assess SD. RESULTS: SD was determined intraoperatively in 51 patients and subsequently confirmed in 50 patients (98.0%). In 18 of 27 patients with inadequate GH decline, immediate reoperation was performed under continuous anesthesia. In 11 of these 18 patients, endocrinologic remission was achieved (14.1%; 11/78). None of the remaining 9 patients who did not undergo secondary surgery achieved remission. Secondary surgery improved the remission rate from 85.7% (12/14) to 92.9% (13/14) in microadenomas and from 70.1% (38/54) to 88.9% (48/54) in transnasally-resectable macroadenomas. Remission was not observed in patients with image proven unresectable lesions. CONCLUSIONS Secondary surgery based on intraoperative GH measurement improves the outcome of tumor resection in patients with transnasally-resectable GH secreting macroadenomas.