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Predicting long-term remission by measuring immediate postoperative growth hormone levels and oral glucose tolerance test in acromegaly

 Kim, Eui Hyun  ;  Oh, Min Chul  ;  Lee, Eun Jig  ;  Kim, Sun Ho 
 NEUROSURGERY, Vol.70(5) : 1106-1113, 2012 
Journal Title
Issue Date
Acromegaly/blood ; Acromegaly/diagnosis* ; Acromegaly/epidemiology ; Acromegaly/surgery* ; Adenoma/blood ; Adenoma/diagnosis ; Adenoma/epidemiology ; Adenoma/surgery ; Adolescent ; Adult ; Aged ; Causality ; Comorbidity ; Female ; Follow-Up Studies ; Glucose Tolerance Test/statistics & numerical data* ; Growth Hormone/blood* ; Growth Hormone-Secreting Pituitary Adenoma/blood ; Growth Hormone-Secreting Pituitary Adenoma/diagnosis* ; Growth Hormone-Secreting Pituitary Adenoma/epidemiology ; Growth Hormone-Secreting Pituitary Adenoma/surgery* ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Postoperative Care/methods ; Postoperative Care/statistics & numerical data ; Prevalence ; Prognosis ; Remission Induction ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Treatment Outcome ; Young Adult
Acromegaly ; Growth hormone ; Oral glucose tolerance test ; Remission ; Transsphenoidal approach
BACKGROUND: The suppression of the growth hormone (GH) on an oral glucose tolerance test (OGTT) has been accepted as the most reliable parameter for determining remission of acromegaly. OBJECTIVE: To evaluate the role of immediate postoperative GH level and 1-week postoperative OGTT as early predictive tools of long-term surgical remission. METHODS: One hundred ninety-four acromegalic patients who received transsphenoidal tumor resection and were followed up for > 1.5 years (3.80 ± 0.17 years) with at least 3 postoperative OGTTs were evaluated. Level of GH was measured 2, 6, 12, 18, 24, 48, and 72 hours postoperatively, and an OGTT was performed 1 week after surgery, every 6 months for the first 3 years, and annually thereafter. RESULTS: One hundred seventy-seven patients underwent gross total resection; long-term remission was achieved in 153. The GH level at 24 hours after surgery showed the highest predictive power for long-term remission. Long-term remission was maintained in 125/127 (98.4%) patients who had nadir GH levels < 1.0 μg/L on an early postoperative OGTT. However, when nadir GH levels were > 1.0 μg/L on an early postoperative OGTT, long-term remission was observed in 28 patients (28 of 67, 41.8%) in a delayed fashion. One-week postoperative OGTT had a sensitivity of 81.7% and specificity of 95.1% for predicting remission. CONCLUSION: Immediate postoperative GH level is a very good predictor of long-term outcome in acromegaly. One-week postoperative OGTT is also a good predictor with high specificity. These findings may provide critical information for the determination of adjuvant treatment after surgery.
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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
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
Oh, Min Chul(오민철)
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
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