- Outcome of Surgery and Radiotherapy in Acromegaly.
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Chan Soo Shin, Chang Hoon Yim, Hee Won Jung, Dae Hee Han, Do Joon Park, Hee Jin Kim, Yun Yong Lee, Kyung Soo Park, Il Han Kim, Sung Yeon Kim, Hong Gyu Lee
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J Korean Endocr Soc. 1998;13(2):156-166. Published online January 1, 2001
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 Abstract
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- BACKGROUND
The primary goal of therapy for acmmegaly is to reduce excess growth hormone (GH) secretion through surgical excision of pituitary adenoma and, in patients with large tumors, to debulk tumor mass and decompress adjacent structures. For the patients in whom surgery is contraindicated or has failed, radiotherapy should be considered. However, there was no analysis of the outcome folIowing the treatment of acromegly in Korea. METHODS: We retrospectively reviewed 128 patients who underwent surgical excision or radiotherapy for acromegaly and followed at our hospital between January 1980 and July 1997 to investigate the outcome of surgny and radiotherapy for acromegaly and to analyze preoperative and preradiotherapeutic parameters that predict a successful outcome of therapy. RESULTS: Pituitary adenomectomy was underwent to the 113 patients with acromegaly, then 33.6% of them showed basa1 GH levels below 5 ug/L and basal GH levels were dropped below 2.5 ug/L in 22.1% of the 113 patients. Postoperative basal GH levels were significantly correlated with preoperative tumor size(r=0.54, p<0.05) and preoperative GH levels(r=0.44, p<0.05). A successful outcome of surgery was influenced by preoperative tumor size, preoperative GH level and extrasellar extension. Multivariate analysis indicated that preoperative tumor size was an independent significant factor affecting the postoperative outcome(OR=2.19, p<0.05). After radiotherapy, the median years of decrease GH<10ug/L and <5ug/L were 3.7 and 7.8, respectively and GH levels of <5ug/L occurred in 35 percent of the patients at 5 years and in 56 percent at 10 yeats. The outcome of radiotherapy depends on the GH levels in preradiotherapy. CONCLUSION: The most reliable prognostic preoperative parameter of successful outcome of surgery was preoperative tumor size and the rate of fall in serum GH after radiotherapy is comparable to the preradiotherapy GH levels in our study, so that early diagnosis and proper treatment can improve the outcome of therapy in the patients with acromegaly. In the cases of large GH-secreting pituitary adenoma, it is required a combination of surgery and radiotherapy to achieve maximal suppresssion of GH levels before radiotherapy.
- The Localization of Microadenoma with Sella Imaging Study and Inferior Petrosal Sinus Sampling in Cushing's Disease.
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Jae Seok Jeon, Sang Jeon Choi, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hee Won Jung, Dae Hee Han, Moon Hee Han, Kee Hyun Chang
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J Korean Endocr Soc. 1996;11(4):492-499. Published online November 7, 2019
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Abstract
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- Background
Inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushings syndrome and for the preoperative lateralization of pituitary microadenoma. We tried to analyze the relative value of IPSS in localization of microadenoma as compared with sella imaging study including computerized tomogram(CT) or magnet resonance imaging(MRI) in Cushings disease. Methods: We reviewed the clinical records of 21 patients with Cushings disease who underwent IPSS and the radiologic study such as sella CT or sella MRI preoperatively followed by transsphenoidal microsurgery. By pathologic examination including immunohistochemistry and postoperative clinical and biochemical evaluation we confirmed the diagnosis of Cushings disease due to pituitary microadenoma in all 21 cases. Results: Sella CT or sella MRI detected microadenoma in 57.1% of cases( =12/21), while recently available dynamic MRI did so in 7 out of S cases. With IPSS the diagnosis of Cushings disease was possible in 90.5% of cases(= 19/21), but accurate lateralization of microadenoma was achieved in only 63.2% of cases( =12/19). IPSS precisely localized the pituitary microadenoma in 6 out of 9 cases whose lesion were not detected by the radiologic study. Of 7 cases in which IPSS failed to localize microadenoma, the radiologic study detected the lesion in 6 cases. Of 5 cases in which IPSS and the radiologic study showed a discrepancy in location of microadenoma, the radiologic study correctly localizaed the lesion in 4 cases and IPSS did so in one case. Conclusion: IPSS is not more reliable than sella imaging study for preoperative localization of microadenoma in Cushings disease. However it might have a complementary role, especially when sella imaging study failed to visualize the lesion.
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