Evaluation of surgery for acromegaly: role of intraoperative growth hormone measurement?

Valdemarsson, S., Ljunggren, S., Cervin, A., Svensson, C., Isaksson, A., Nordstrom, C. -H. and Siesjo, P. (2001) Evaluation of surgery for acromegaly: role of intraoperative growth hormone measurement?. Scandinavian Journal of Clinical and Laboratory Investigation, 61 6: 459-470. doi:10.1080/00365510152567103


Author Valdemarsson, S.
Ljunggren, S.
Cervin, A.
Svensson, C.
Isaksson, A.
Nordstrom, C. -H.
Siesjo, P.
Title Evaluation of surgery for acromegaly: role of intraoperative growth hormone measurement?
Journal name Scandinavian Journal of Clinical and Laboratory Investigation   Check publisher's open access policy
ISSN 0036-5513
1502-7686
Publication date 2001-01-01
Year available 2001
Sub-type Article (original research)
DOI 10.1080/00365510152567103
Open Access Status Not yet assessed
Volume 61
Issue 6
Start page 459
End page 470
Total pages 12
Place of publication Abingdon, Oxfordshire, United Kingdom
Publisher Taylor & Francis
Language eng
Formatted abstract
Objective: Intraoperative growth hormone (GH) measurement has earlier been tried to improve surgery for acromegaly. We calculated GH half-life after adenomectomy and evaluated the possible role of this variable in predicting the final outcome of pituitary surgery in 28 consecutive patients with acromegaly. The sensitivity, specificity and predictive values were determined in relation to the results from GH suppression during an oral glucose load and IGF-1 3 months postoperatively. The GH half-life data were also compared to the corresponding results obtained from GH measurements between 60 min and 180 min after adenomectomy, and early, within 1 week, postoperatively.

Results: GH half-life ≤ 31 min was recorded in 8/13 cured patients but also in 2/15 unsuccessful cases. A mean GH concentration ≤ 4.4 mU/L between 60 min and 120 min after adenomectomy was found in 11/13 cured subjects but also in 3/15 not cured patients. A mean GH ≤ 4.0 mU/L between 90 min and 180 min was found in 11/13 cured and in 4/15 not cured patients. A mean early postoperative GH concentration ≤ 2.6 mU/L was noted in all 13 cured patients, but also in 2/13 unsuccessful cases. The specificity of early postoperative GH ≤ 2.6 mU/L was 100% compared to 62% for a GH half-life ≤ 31 min (p < 0.05) and 85% for the GH mean values between 60 min and 120 min and 90 min and 180 min, respectively. The sensitivity for persistent disease of values above the four cut-off limits used was between 73% and 87%. The positive predictive value for a mean early postoperative GH value > 2.6 mU/L was 100%, and 72% for a GH half-life > 31 min (n.s.).

Conclusion: Although intraoperative GH half-life might be useful in some cases, it was not a reliable tool for predicting outcome of pituitary surgery in acromegaly. In cases with a 50% decrease of a basal GH concentration > 5.5 mU/L, mean GH values ≤ 4 to ≤ 4.4 mU/L late intraoperatively were more informative but not as good as those obtained from the mean of a series of GH values drawn on one occasion within 1 week postoperatively, offering a 100% specificity for cure if ≤ 2.6 mU/L. Intraoperative GH half-life measurements should therefore be used with caution. The predictive values of the cut-off limits used in this study should be further evaluated before general application.
Keyword Acromegaly
Growth hormone
Pituitary disease
Pituitary function
Pituitary surgery
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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