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Age- and Sex-Specific Differences as Predictors of Surgical Remission Among Patients With Acromegaly

Authors
 Se Hee Park  ;  Cheol Ryong Ku  ;  Ju Hyung Moon  ;  Eui Hyun Kim  ;  Sun Ho Kim  ;  Eun Jig Lee 
Citation
 JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, Vol.103(3) : 909-916, 2018 
Journal Title
 JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM 
ISSN
 0021-972X 
Issue Date
2018
MeSH
Acromegaly/blood/etiology/*surgery ; Adenoma/blood/complications/pathology/*surgery ; Adult ; Age Factors ; Female ; Growth Hormone-Secreting Pituitary Adenoma/blood/complications/pathology/*surgery ; Human Growth Hormone/blood/secretion ; Humans ; Insulin-Like Growth Factor I/metabolism ; Male ; Middle Aged ; Neoplasm Invasiveness ; Premenopause ; Prognosis ; Remission Induction ; Retrospective Studies ; Sex Characteristics ; Sex Factors ; Treatment Outcome
Abstract
Context: Sex and age are factors conferring resistance to medical treatment in patients with acromegaly. However, their impact on outcomes of transsphenoidal-selective adenomectomy (TSA) has not been evaluated. Objective: To analyze age- and sex-related differences concerning surgical outcomes of growth hormone (GH)-secreting pituitary adenomas. Design: Retrospective. Setting: Single-center tertiary hospital. Participants: Patients with acromegaly (n = 463) who underwent TSA between January 2000 and July 2014. Intervention: TSA. Main Outcome Measurements: Tumor characteristics and surgical outcomes. Results: Sex differences existed in the baseline insulinlike growth factor-1 levels and the mean tumor size. Overall, surgical remission rates were 89.7% and 76.5% in male and female patients, respectively (P < 0.001). Total tumor tissue resection was performed in 92.6% and 85.8% of male and female participants, respectively (P = 0.021). Premenopausal women had a higher proportion of pituitary adenoma with cavernous sinus invasion than did men aged <50 years (35.3% vs 21.7%, P = 0.007). In immediate postoperative, 75-g oral glucose tolerance tests, fewer premenopausal women reached <1 ng/dL nadir GH levels than did men aged <50 years (59.9% vs 87.7%, P < 0.001). Surgical results were similar in both sexes among older patients (>/=50 years). However, premenopausal women had significantly lower long-term remission rates than did men aged <50 years (69.3% vs 88.0%, P < 0.001). Conclusion: Premenopausal women with acromegaly tend to have larger tumors, more aggressive tumor types, and lower remission rates than do men. However, further studies on the clinical implications are needed.
Full Text
https://academic.oup.com/jcem/article/103/3/909/4764024
DOI
10.1210/jc.2017-01844
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Moon, Ju Hyung(문주형)
Park, Se Hee(박세희)
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162629
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