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Q J Med 1999; 92: 741-745
© 1999 Association of Physicians

Outcome of surgery for acromegaly—the experience of a dedicated pituitary surgeon

N.J.L. Gittoes, M.C. Sheppard, A.P. Johnson1 and P.M. Stewart

From the Division of Medical Sciences, University of Birmingham, and 1 Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK

Received 23 June 1999 and in revised form 2 September 1999

Professor P.M. Stewart, Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH

Previous large series of outcome following pituitary surgery for acromegaly, including our own, have demonstrated poor results, with cure, defined as GH <5 mU/l, achieved in only 33–42% of patients. In our previous series, surgery was performed by one of eight different surgeons. Largely based on the disappointing results of this previous audit of outcome, our practice since 1990 has been, whenever possible, to refer all patients with acromegaly to a dedicated pituitary surgeon (APJ). The objective of the current study was to re-analyse the outcome of surgical treatment for acromegaly since instituting this change. Tumour size and extension was determined on CT/MRI scanning. Biochemical cure was defined as a basal GH <5 mU/l or a nadir GH of <2 mU/l across an OGTT following initial pituitary surgery. Surgery was performed on 66 patients and 42 (64%) were cured, compared with 26/78 (33%) in our previous study (p<0.0005, {chi} 2 test). The cure rate for microadenomas (n=22) was 86%, and for macroadenomas 52%, compared with 54% (p<0.05, {chi} 2 test) and 30% (p<0.05, {chi} 2 test) respectively, in our previous study. We conclude that surgical outcome for acromegaly is enhanced if patients are operated on by a single experienced surgeon.


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