Endocrine Accompaniments in Acromegaly Patients Before and After Surgery

Background and Aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH – secreting adenomas. The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral adenohypophyseal hormones. In addition, the pituitary hormones have also been measured directly in the adenoma tissue following its surgical removal.Methods: The present study is based on 07 patients (04 males and 3 females), 30-50 year of age, diagnosed for Functional Pituitary Adenomas (FPAs) on the basis of clinical and radiological evidence. An equal number of age matched healthy subjects were included as controls. Follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), growth hormone (GH) and prolactin (PRL) were determined in serum before and following trans-sphenoidal adenomectomy. The GH, FSH, TSH and PRL content of the excised adenoma tissue was also measured in male patients. All hormone determinations were carried out using commercially available immuno-assay kits (ELISA and IRMA) in duplicate.Results: The results demonstrate that the mean serum GH levels in the 04 male and 03 female patients with FPAs were found to be significantly higher before surgical removal as compared to those obtained following surgery. Significant differences were observed between pre- and postsurgical serum GH levels in male and female patients with FPA. GH content was also determined in the male adenoma tissue. Following removal of the adenoma in these 4 male and 03 female patients, peripheral serum GH levels fell within the normal range. The adenoma tissue GH content in patients with initial higher serum GH levels was also significantly greater than that of the other patients. The mean serum PRL concentration in male patients before removal of the adenoma and values obtained after surgical removal of the adenoma and those of control subjects were not significantly different. The mean PRL concentration of the adenoma tissue in all the male patients was not significantly different from the control pituitary tissue. However, the presurgical mean serum PRL concentration were significantly higher in 2 of the 3 female patients included in this study as compared to the control values. Following removal of adenoma, normal serum levels were attained in those patients. In the remaining one female patient serum PRL concentra-tion was within the normal range before and following surgical removal of the adenoma. The mean serum FSH levels in the 04 male patients with FPAs were not significantly different before and after surgical removal of ade-noma tissue. However, an examination of individual values reveals higher FSH levels in 02 of the male patients and in 01 of the three premenopausal female patients. Following surgical removal of the adenoma, serum FSH concentrations showed a marked decline of FSH levels in those patients. However, the remaining two females showed normal FSH levels before and after surgery. The adenoma FSH content of these patients was not signifi-cantly higher than those of the control pituitary tissue. No significant differences were observed between pre and post-surgical serum TSH levels. The TSH content of adenoma tissue was either non-detectable or in the low range as compared to the TSH content determined in control pooled pituitary tissue.Conclusion: Transsphenoidal surgery is thought to be an effective primary treatment for GH-secreting pituitary adenomas according to the most recent criteria of cure. Because the remission rate in cases with cavernous sinusEndocrine Accompaniments in Acromegaly Patients Before and After Surgery invasion is very low, early detection of the tumor before it extends into the cavernous sinus and a long-term endocrinological and radiological follow-up are necessary in order to improve the remission rate of acromegaly