TY - JOUR
T1 - Wide variation in surgical outcomes for acromegaly in the UK
AU - Bates, P.R.
AU - Carson, M.N.
AU - Trainer, P.J.
AU - Wass, J. A. H.
AU - Bevan, J.S.
AU - Atkinson, A.B.
AU - Peacey, S.R.
AU - Stewart, P.M.
AU - Sheppard, M.C.
AU - Dayan, C.M.
AU - Chatterjee, K.
AU - Scanlon, M.F.
AU - Leese, G. P.
AU - Walker, B.R.
AU - Patrick, A.W.
AU - Vaidya, B.
AU - Connell, J. M. C.
AU - Allan, B.
AU - Atkin, S.L.
AU - Orme, S.
AU - Howlett, T.A.
AU - Vora, J.P.
AU - Jenkins, P.J.
AU - Aylwin, S.
AU - Bouloux, P.
AU - Davis, J.R.E.
AU - Shalet, S.
AU - James, R.A.
AU - Howell, S.J.
AU - Vice, P.A.
AU - Newell-Price, J.
AU - Ross, R.J.M.
AU - Clayton, R.N.
AU - Jennings, P.
AU - Booth, A.
AU - Alexander, A.
AU - Holden, N.
AU - Jablonski, L.
AU - Wright, D.
AU - Hunt, M.
AU - Taheri, J.
AU - Holmes, C.
AU - Woods, E.
AU - Brown, T.
AU - Roberts, S.
AU - Carson, M.
AU - Goss, L.
AU - Revesz, S.
AU - Campbell, K.
AU - Grant, D.
AU - Smith, C.
AU - Cleary, S.
AU - Spink, C.
AU - Howlett, T.
AU - Chapman, M.
AU - Corlett, P.
AU - Morton, B.
AU - Whittingham, P.
AU - Conrich, L.
AU - Gaygon, C.
AU - Owusu-Antwi, S.
AU - Stobie, E.
AU - Walker-Scott, E.
AU - Gilbert, J.
AU - Drowley, T.
AU - Gibson, C.
AU - Roberts, M.
AU - Gebbie, J.
AU - Henderson, P.
AU - Johnstone, K.
AU - Murphy, A.
AU - Cowshill, C.
AU - Fazal-Sanderson, V.
AU - Smith, R.
AU - Parkington, S.
AU - Doane, A.
AU - Ibbotson, V.
AU - Lynch, R.
AU - Brown, M.
AU - Barry, E.
AU - Brown, N.
N1 - Cited By (since 1996): 22
Export Date: 19 March 2012
Source: Scopus
CODEN: CLENA
doi: 10.1111/j.1365-2265.2007.03012.x
Language of Original Document: English
Correspondence Address: Wass, J.A.H.; Department of Endocrinology, Churchill Hospital, Oxford OX3 7LJ, United Kingdom; email: [email protected]
Chemicals/CAS: growth hormone, 36992-73-1, 37267-05-3, 66419-50-9, 9002-72-6; somatomedin C, 67763-96-6
References: Melmed, S., Medical progress: Acromegaly (2006) New England Journal of Medicine, 355, pp. 2558-2573; Lissett, C.A., Shalet, S.M., Management of pituitary tumours: Strategy for investigation and follow-up (2000) Hormone Research, 53 (3), pp. 65-70; Giustina, A., Barkan, A., Casanueva, F.F., Cavagnini, F., Frohman, L., Ho, K., Veldhuis, J., Melmed, S., Criteria for cure of acromegaly: A consensus statement (2000) Journal of Clinical Endocrinology and Metabolism, 85, pp. 526-529; Bates, A.S., Van'T Hoff, W., Jones, J.M., Clayton, R.N., An audit of outcome of treatment in acromegaly (1993) Quarterly Journal of Medicine, 86, pp. 292-299; Orme, S.M., McNally, R.J.Q., Cartwright, R.A., Belchetz, P.E., Mortality and cancer incidence in acromegaly: A retrospective cohort study (1998) Journal of Clinical Endocrinology and Metabolism, 83, pp. 2730-2734; Swearingen, B., Barker, F.G., Katznelson, L., Biller, B.M.K., Grinspoon, S., Klibanski, A., Moayeri, N., Zervas, N.T., Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly (1998) Journal of Clinical Endocrinology and Metabolism, 83, pp. 3419-3426; Abosch, A., Tyrell, J.B., Lamborn, K.R., Hannegan, L.T., Applebury, C.B., Wilson, C.B., Transsphenoidal microsurgery for growth hormone secreting pituitary adenomas: Initial outcome and long-term results (1998) Journal of Clinical Endocrinology and Metabolism, 83, pp. 3411-3418; Gittoes, N.J.L., Sheppard, M.C., Johnson, A.P., Stewart, P.M., Outcome of surgery for acromegaly - The experience of a dedicated pituitary surgeon (1999) Quarterly Journal of Medicine, 92, pp. 741-745; Ahmed, S., Elsheikh, M., Stratton, I.M., Page, R.C.L., Adams, C.B.T., Wass, J.A.H., Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience (1999) Clinical Endocrinology, 50, pp. 561-567; Sheaves, R., Jenkins, P., Blackburn, P., Huneidi, A.H., Afshar, F., Medbak, S., Grossman, A.B., Wass, J.A., Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure (1996) Clinical Endocrinology, 45, pp. 407-413; Lissett, C.A., Peacey, S.R., Laing, I., Tetlow, L., Davis, J.R.E., Shalet, S.M., The outcome of surgery for acromegaly: The need for a specialist pituitary surgeon for all types of growth hormone (GH) secreting adenoma (1998) Clinical Endocrinology, 49, pp. 658-657; Clayton, R.N., Stewart, P.M., Shalet, S.M., Wass, J.A., Pituitary surgery for acromegaly. Should be done by specialists (1999) British Medical Journal, 319, pp. 588-589; Abe, T., Ludecke, D.K., Recent results of secondary transnasal surgery for residual or recurring acromegaly (1998) Neurosurgery, 42, pp. 1013-1021; Nomikos, P., Buchfelder, M., Fahlbusch, R., The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure' (2005) European Journal of Endocrinology, 152, pp. 379-387; Osman, I.A., James, R.A., Chatterjee, S., Mathias, D., Kendall-Taylor, P., Factors determining the long-term outcome of surgery for acromegaly (1994) Quarterly Journal of Medicine, 87, pp. 617-623; Van Lindert, E., Hey, O., Boecher-Scwartz, H., Perneczky, A., Treatment results of acromegaly as analysed by different criteria (1997) Acta Neurochirurgica, 139, pp. 905-912; Jenkins, P.J., Bates, P., Carson, M.N., Stewart, P.M., Wass, J.A., Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly (2006) Journal of Clinical Endocrinology and Metabolism, 91, pp. 1239-1245; Biermasz, N.R., Van Dulken, H., Roelfsema, F., Ten-year follow-up results of transsphenoidal microsurgery in acromegaly (2000) Journal of Clinical Endocrinology and Metabolism, 85, pp. 4596-4602; Freda, P.U., Sharon, S.L., Post, K.D., Long term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly (1998) Journal of Neurosurgery, 89, pp. 353-358; De, P., Rees, D.A., Davies, N., John, R., Neal, J., Mills, R.G., Vafidis, J., Scanlon, M.F., Transsphenoidal surgery for acromegaly in Wales: Results based on stringent criteria of remission (2003) Journal of Clinical Endocrinology and Metabolism, 88, pp. 3567-3572; Barrande, G., Pittino-Lungo, M., Coste, J., Ponvert, D., Bertagna, X., Luton, J.P., Bertherat, J., Hormonal and metabolic effects of radiotherapy in acromegaly: Long-term results in 128 patients followed in a single center (2000) Journal of Clinical Endocrinology and Metabolism, 85, pp. 3779-3785; Brada, M., Ford, D., Ashley, S., Bliss, J.M., Crowley, S., Mason, M., Rajan, B., Traish, D., Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma (1992) British Medical Journal, 304, pp. 1343-1346; Trainer, P.J., Drake, W.M., Katznelson, L., Freda, P.U., Herman-Bonert, V., Van Der Lely, A.J., Dimaraki, E.V., Davis, R.J., Treatment of acromegaly with the growth hormone-receptor antagonist pegvisomant (2000) New England Journal of Medicine, 20 (342), pp. 1171-1177; Yamada, S., Aiba, T., Takada, K., Ozawa, Y., Shimuzu, T., Sawano, S., Shishiba, Y., Sano, T., Retrospective analysis of long-term surgical results in acromegaly: Preoperative and post-operative factors predicting outcome (1996) Clinical Endocrinology, 45, pp. 291-298; Colao, A., Attanasio, R., Pivonello, R., Cappabianca, P., Cavallo, L.M., Lasio, G., Lodrini, A., Cozzi, R., Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly (2006) Journal of Clinical Endocrinology and Metabolism, 91, pp. 85-92; Ciric, I., Ragin, A., Baumgartner, C., Pierce, D., Complications of transsphenoidal surgery: Results of a national survey, review of the literature, and personal experience (1997) Neurosurgery, 40, pp. 225-236; Yamada, S., Takada, K., Ozawa, Y., Shimuzu, T., Sawano, S., Shishiba, Y., Sano, T., Usui, M., The results of transsphenoidal surgery for 44 consecutive acromegalic patients (1997) Endocrine Journal, 44, pp. 395-402; Clayton, R.N., How many surgeons to operate on acromegalic patients? (1999) Clinical Endocrinology, 50, pp. 557-559; Barker II, F.G., Klibanski, A., Swearingen, B., Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: Mortality, morbidity, and the effects of hospital and surgeon volume (2003) Journal of Clinical Endocrinology and Metabolism, 88, pp. 4709-4719
PY - 2008
Y1 - 2008
N2 - Objective: Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series. Design: Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services. Patients: Cases of acromegaly, presenting in 1970-2004, with levels of GH or IGF-1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH-lowering pharmacological therapy was permitted only if suspended for biochemical testing. Measurements: Percentage of cases with 'safe' mean postoperative GH levels (<5 mU/l) and/or IGF-1 in the age- and sex-adjusted normal range. Results: 'Safe' GH, normal IGF-1, or both was achieved for 26%, 29% and 20% of extrasellar macroadenomas (> 1 cm), respectively, 39%, 39% and 29% of intrasellar macroadenomas, 56%, 51% and 37% of microadenomas (<1 cm) and 39%, 39% and 28% of cases overall. In centres contributing more than 10 patients' data, rates of safe GH levels ranged from 20% to 68% and IGF-1 from 19% to 55%. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter. Conclusions: Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60%. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF-1 levels for the majority of cases. © 2007 The Authors.
AB - Objective: Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series. Design: Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services. Patients: Cases of acromegaly, presenting in 1970-2004, with levels of GH or IGF-1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH-lowering pharmacological therapy was permitted only if suspended for biochemical testing. Measurements: Percentage of cases with 'safe' mean postoperative GH levels (<5 mU/l) and/or IGF-1 in the age- and sex-adjusted normal range. Results: 'Safe' GH, normal IGF-1, or both was achieved for 26%, 29% and 20% of extrasellar macroadenomas (> 1 cm), respectively, 39%, 39% and 29% of intrasellar macroadenomas, 56%, 51% and 37% of microadenomas (<1 cm) and 39%, 39% and 28% of cases overall. In centres contributing more than 10 patients' data, rates of safe GH levels ranged from 20% to 68% and IGF-1 from 19% to 55%. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter. Conclusions: Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60%. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF-1 levels for the majority of cases. © 2007 The Authors.
KW - growth hormone
KW - somatomedin C
KW - acromegaly
KW - adenoma
KW - article
KW - controlled study
KW - growth hormone blood level
KW - human
KW - major clinical study
KW - medical record review
KW - observational study
KW - postoperative period
KW - priority journal
KW - prospective study
KW - retrospective study
KW - transsphenoidal hypophysectomy
KW - transsphenoidal surgery
KW - treatment outcome
KW - United Kingdom
U2 - 10.1111/j.1365-2265.2007.03012.x
DO - 10.1111/j.1365-2265.2007.03012.x
M3 - Article
C2 - 17803712
SN - 0300-0664
VL - 68
SP - 136
EP - 142
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 1
ER -