Acromegaly: Biochemical Assessment of Cure after Long Term Follow-Up of Transsphenoidal Selective Adenomectomy*

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Abstract
This study reports the clinical and biological follow-up 5-11 yr after transsphenoidal selective adenomectomyin 25 patients with acromegaly. Eight patients had microadenomas,and 17 had macroadenomas. Initial normalization ofplasma GH levels (basal values, <5 ng/ml; glucose-suppresedconcentrations, <2.5 ng/ml) was achieved in all 8 patients withmicroadenomas and in 13 patients with macroadenomas. Ofthese, 3 patients with normal GH levels and dynamics hadrelapse of GH hypersecretion after intervals between 1–6 yr aftermicroadenoma removal. Recurrence of pituitary adenoma wasdocumented by surgery in 1 patient and by computed tomographic scanning in 2 others. Normal basal and glucose-suppressedplasma GH concentrations were maintained 7.4 ± 0.5(±SEM) yr after adenomectomy in 7 patients with microadenomasand in all 10 patients with macroadenomas. Thus, 88% ofthe patients with microadenomas and 59% of the patients withmacroadenomas were cured, and the overall cure rate was 68%.We conclude that recurrence of acromegaly after successfulsurgery may occur late after adenoma removal and that it cannotbe predicted by normal postoperative GH levels and dynamics.However, in view of the overall cure rate, transsphenoidal adenomectomyremains a most valuable treatment for acromegaly.