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

 Se Hee Park  ;  Cheol Ryong Ku  ;  Ju Hyung Moon  ;  Eui Hyun Kim  ;  Sun Ho Kim  ;  Eun Jig Lee 
 Journal of Clinical Endocrinology & Metabolism, Vol.103(3) : 909-916, 2018 
Journal Title
 Journal of Clinical Endocrinology & Metabolism 
Issue Date
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
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.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실)
Yonsei Authors
구철룡(Ku, Cheol Ryong) ORCID logo https://orcid.org/0000-0001-8693-9630
김선호(Kim, Sun Ho) ORCID logo https://orcid.org/0000-0003-0970-3848
김의현(Kim, Eui Hyun) ORCID logo https://orcid.org/0000-0002-2523-7122
문주형(Moon, Ju Hyung)
박세희(Park, Se Hee)
이은직(Lee, Eun Jig) ORCID logo https://orcid.org/0000-0002-9876-8370
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