{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T02:45:00Z","timestamp":1780368300672,"version":"3.54.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Acromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor\u20131 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH\/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The 52 patients had a mean age of 50.7 \u00b1 13.4 years and a mean follow-up duration of 24.4 \u00b1 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Endoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2020.3.focus2080","type":"journal-article","created":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T08:21:59Z","timestamp":1591172519000},"page":"E10","source":"Crossref","is-referenced-by-count":34,"title":["Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly"],"prefix":"10.3171","volume":"48","author":[{"given":"Tyler","family":"Cardinal","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Micko","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California;"},{"name":"Department of Neurosurgery, Medical University of Vienna, Austria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Keck School of Medicine of University of Southern California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Shang","family":"Jason Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Neuroradiology, Keck School of Medicine of University of Southern California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bozena","family":"Wrobel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Keck School of Medicine of University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California;"},{"name":"Department of Medicine, Division of Endocrinology and Diabetes, Keck School of Medicine of University of Southern California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1111\/j.1365-2265.2012.04492.x","article-title":"Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients","volume":"78","author":"Albarel F","year":"2013","unstructured":"Albarel F, Castinetti F, Morange I, Conte-Devolx B, Gaudart J, Dufour H, : Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients. 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