Trans-Sphenoidal Surgery in 95 Acromegalic Patients: Clinical and Radiological Findings

Acromegaly, a multisystem disease, produced by growth hormone (GH) secreting pituitary adenomas, has devastating effects shortening life expectancy thus control of the disease is vital. Surgical removal of adenomas is the primary and standard treatment in these patients. In this study, results of trans-sphenoidal surgery in 95 patients admitted consecutively to the Shohada-e Tadjrish Hospital, over 9 years beginning 1996, were analyzed. Data were collected retrospectively from files of all patients admitted to our hospital, over 9 years, and operated using a trans-sphenoidal approach. Clinical and radiological evaluations were reviewed and intra-operative findings, postoperative complications, immediate hormonal assay results and long term follow ups were analyzed. Forty eight patients were female and 47 male (1/1 ratio) with mean age of 39.2 ± 12 years. Acromegalic features were present in almost every patient with a mean duration of 46 ± 43 months. Macroadenomas were discovered in 70 patients and microadenomas in the other 25 there was no mortality. Postoperative complications were as follows: Temporary DI in 80, CSF rhinorrhea in 11 and meningitis in 4 (all were managed conservatively with only one case of permanent DI) 79 patients had follow up (mean 13±12 months) 64% of patients (76% of microadenomas and 62% of macroadenomas) had remission (post-operative GH < 5 ng/mL), but with remission criteria of GH < 2.5 ng/mL there was 51% remission rate (65% of microadenomas and 44% of macroadenomas). In five patients, following initial surgery, there was recurrence after 1 to 4 years, which was controlled in 4 of with a second trans-sphenoidal surgery, with the remaining one case being referred for radiotherapy.