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Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis

  • Clinical Article - Brain Tumors
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Abstract

Background

In 2010, the Acromegaly Consensus Group revised 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 incidence and management has not been established. The objective 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 subgroups of patients.

Methods

Systematic review and meta-analysis of surgical series 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 pituitary 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 required to determine the long-term biochemical remission rates and clinical implications.

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Authors and Affiliations

  1. Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (Unil), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Daniele Starnoni, Roy Thomas Daniel, Marc Levivier & Mahmoud Messerer

  2. Service d’Endocrinologie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (Unil), Lausanne, Switzerland

    Laura Marino & Nelly Pitteloud

Authors
  1. Daniele Starnoni
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  2. Roy Thomas Daniel
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  3. Laura Marino
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  4. Nelly Pitteloud
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  5. Marc Levivier
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Correspondence to Mahmoud Messerer.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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The authors declare no financial conflict of interest concerning the materials or methods used in this study of the findings specified in this paper.

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Comments

This is an interesting article reporting results from a meta-analysis on remission rates after transsphenoidal surgery for GH secreting pituitary adenomas according to the stricter 2010 criteria. As expected, the remission rate was poorer than according to the 2000 criteria and the best outcome was obtained for micro-adenomas and non-invasive adenomas. From a clinical point of view, the decision for treatment of the patients not in remission according to the 2010 criteria but in remission according to the 2000 criteria is a dilemma. Likewise, the care of patients with discordant GH and IGF-I levels is a challenge. This is all discussed in the article, which provides important clinical information.

Charlotte Hoybe

Stockholm, Sweden

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Starnoni, D., Daniel, R.T., Marino, L. et al. Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis. Acta Neurochir 158, 2109–2121 (2016). https://doi.org/10.1007/s00701-016-2903-4

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