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Transsphenoidal adenomectomy outcomes worse in premenopausal women with acromegaly
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Among adults with acromegaly who undergo transsphenoidal adenomectomy, premenopausal women have a worse long-term remission rate and are more likely to have remnant mass and higher serum growth hormone levels compared with postmenopausal women and men, study data show.
Eun Jig Lee, MD, PhD, of the department of internal medicine at Yonsei University College of Medicine in Korea, and colleagues evaluated data from 463 adults (mean age, 42.9 years; 203 men) with acromegaly who underwent transsphenoidal adenomectomy between 2000 and July 2014 at Severance Hospital in Korea to analyze age- and sex-related differences in surgical outcomes of GH-secreting pituitary adenomas. Follow-up after surgery was a mean of 61.4 months.
Evaluations of participants included 75-g oral glucose tolerance tests and measurement of insulin-like growth factor I performed every 6 months during the first 3 years after surgery and then annually.
Participants were divided into groups based on sex and age: men younger than 50 years, premenopausal women, men aged at least 50 years and postmenopausal women.
Compared with men, women were older (39.9 years vs. 45.2 years; P < .001), had lower preoperative IGF-I level (781.7 ng/mL vs. 667 ng/mL; P < .001), larger tumor size (15.7 mm vs. 18 mm; P = .002), a higher proportion of tumors with cavernous sinus invasion (20.2% vs. 29.2%; P = .026), lower tumor resection rate (92.6% vs. 85.8%; P = .021) and lower long-term surgical remission rate (89.7% vs. 76.5%; P < .001).
Compared with men aged at least 50 years and postmenopausal women, men younger than 50 years and premenopausal women had higher preoperative random GH (19.2 ng/mL vs. 29.7 ng/mL; P = .001), OGTT nadir GH (14.2 ng/mL vs. 22.4 ng/mL; P < .001) and IGF-I (675.6 ng/mL vs. 735.1 ng/mL; P = .002) levels, had longer mean maximal tumor diameter (15.2 mm vs. 17.9 mm; P < .001), a higher proportion of adenomas with cavernous sinus invasions (18.8% vs. 28.2%; P = .03), lower tumor resection rate (95.8% vs. 85.6%; P = .001) and lower long-term surgical remission rate (89.6% vs. 79%; P = .006).
Compared with men younger than 50 years, premenopausal women had lower preoperative IGF-I level (793.6 ng/mL vs. 673.9 ng/mL; P < .001), larger tumor size (16.2 mm vs. 19.7 mm; P < .001), lower tumor resection rate (91% vs. 79.7%; P = .004) and worsened hypopituitarism after surgery (3.8% vs. 11.6%; P = .009); fewer reached less than 1 ng/dL nadir GH levels in immediate postoperative OGTT (87.7% vs. 59.9%; P < .001).
Premenopausal women had higher serum GH levels over time after surgery, were more likely to have remnant mass and fewer achieved less immediate postoperative biochemical remission rate compared with the three other groups. Long-term remission rate was lowest in premenopausal women (69.3%) compared with men younger than 50 years (88%), men older than 50 years (97.3%) and postmenopausal women (86.9%).
Surgical failure was significantly associated with younger age (premenopausal women and men younger than 50 years; OR = 3.48; 95% CI, 1.21-10.03), female sex (OR = 3.63; 95% CI, 1.37-9.6), large tumor size (OR = 1.16; 95% CI, 1.09-1.24) and cavernous sinus invasion (OR = 5.68; 95% CI, 1.11-29.08).
“Considering the retrospective design of this study, potential bias during data collection might exist,” the researchers wrote. “Furthermore, the patients included in this study were all from a tertiary medical center in South Korea. Hence, prospective studies conducted among a large number of patients from multiple centers are needed. We also did not investigate the time duration since the patient developed symptoms and the number of doctors they visited during that period. On average, the longer time from symptoms onset to diagnosis of acromegaly among women with associated with the increased aggressiveness of the disease. An investigation on these aspects would have strengthened the findings of this study.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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