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CLINICAL ARTICLE - BRAIN TUMORS
Surgical treatment of acromegaly according to the 2010 remission
criteria: systematic review and meta-analysis
Daniele Starnoni
1
&Roy Thomas Daniel
1
&Laura Marino
2
&Nelly Pitteloud
2
&
Marc Levivier
1
&Mahmoud Messerer
1
Received: 27 April 2016 /Accepted: 19 July 2016 /Published online: 2 September 2016
#Springer-Verlag Wien 2016
Abstract
Background In 2010, the Acromegaly Consensus Group re-
vised the criteria for cure of acromegaly and thus rates of
surgical remission need to be revised in light of these new
thresholds.
Two subgroups consisted of patients with discordant GH
and IGF-1 levels and patients in remission according to the
2000 criteria, but not to the 2010 criteria, have been reported
after adenomectomy and for these subgroups the precise inci-
dence and management has not been established. The objec-
tive of the study was to update rates of surgical remission and
complications and to evaluate the incidence, management,
and long-term outcome of the two previously described sub-
groups of patients.
Methods Systematic review and meta-analysis of surgical se-
ries that defined remission according to the 2010 biochemical
criteria.
Results We included 13 studies (1105 patients). The pooled
rate of overall surgical remission was 54.8 % (95 % CI 44.4–
65.2 %), and 72.2 % with previous criteria. Remission was
achieved in 77.9 % (95 % CI 68.1–87.6 %) of
microadenomas; 52.7 % (95 % CI 41–64.4 %) of
macroadenomas; 29 % (95 % CI 20.1–37.8 %) of invasive
and 68.8 % (95 % CI 60–77.6 %) of non-invasive adenomas.
Complication rates were 1.2 % (95 % CI 0.6–1.9 %) for
CSF leak, 1.3 % (95 % CI 0.6–2.1 %) for permanent diabetes
insipidus, 8.7 % (95 % CI 4.8–12.5 %) for new anterior pitu-
itary dysfunction and 0.6 % (95 % CI 0.1–1.1 %) for severe
intraoperative hemorrhage.
We identified an intermediate group of patients, defined as:
(1) Remission according to one, but not the other biochemical
criteria (GH or IGF-1) or 2010 criteria (14.3 % and 47.1 %
cases), (2) Remission according to 2000, but not 2010 criteria
(13.2–58.8 % cases). Two studies reported a remission rate of
56.5 % and 100 %, in the two subgroups respectively, in a
long-term outcome without adjuvant therapy.
Conclusions Overall remission with transsphenoidal surgery
is achieved in ∼55 % of patients. For the intermediate group of
patients, future prospective studies with long-term follow-up
are requiredto determine the long-term biochemical remission
rates and clinical implications.
Keywords Acromegaly .Growth hormone-secreting pituitary
adenoma .Transsphenoidal surgery .Remission
Introduction
Acromegaly is a rare condition with an underestimated inci-
dence per year of five cases per million and, if uncontrolled, the
disease leads to an almost 2- to 4-fold higher mortality [26].
The necessity of treatment is imperative and the normali-
zation of the biochemical parameters alleviates the symptoms
and reduces the mortality and morbidity rates to those of the
general population. According to the most recent 2014 guide-
lines on acromegaly management, surgery represents the first-
line treatment option with medical and radiation therapy as
second and third lines of treatment, respectively [20].
Criteria of biochemical remission are in constant evolution;
in 1999, the first consensus conference in Cortina defined cure
criteria as insulin-like growth factor-I (GF-I) level in age- and
*Mahmoud Messerer
mahmoud.messerer@chuv.ch
1
Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois
(CHUV) and University of Lausanne (Unil), Rue du Bugnon 46,
1011 Lausanne, Switzerland
2
Service d’Endocrinologie, Centre Hospitalier Universitaire Vaudois
(CHUV) and University of Lausanne (Unil), Lausanne, Switzerland
Acta Neurochir (2016) 158:2109–2121
DOI 10.1007/s00701-016-2903-4
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