Presentation and Outcomes in Patients Surgically Treated for Acromegaly at a Newly Established Pituitary Center

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Abstract We evaluated presentation, comorbidities, and long-term outcomes of acromegaly at a newly established pituitary center. We conducted a retrospective chart review of patients who underwent surgery by a single skull-based-trained neurosurgeon between July 2018 and February 2024. We compared presentation and comorbidities in two groups of patients: A (postoperative remission) and B (persistent growth hormone [GH] excess). Tertiary referral academic medical center. Of the 50 patients (52% male, mean age at surgery 48.8 ± 15.0 years) with GH-secreting adenoma, 8 (16%) were incidentally detected, and 11 (22%) had prior surgery by another neurosurgeon. Men (vs. women) were older, with more frequent hypopituitarism and vision changes at presentation. Group A (postoperative remission) included 25 patients. Low immediate postoperative GH levels (cutoff 1.705 ng/mL, area under the curve [AUC] 0.81) predicted durable postoperative remission. Mean GH levels were lower in Group A (vs. Group B) throughout the postoperative follow-up period of 39.5 months (12.53, 51.58). Group B had more hyperglycemia (p = 0.04) and overall comorbidities (p = 0.03). Hyperglycemia was significantly associated with lower odds of postoperative remission (odds ratio 0.306, p = 0.043). At last follow-up (median 39.5 months; interquartile range [IQR] 12.53, 51.58), 37/49 (75%) patients attained biochemical control, including 25 in group A and 12 in group B, the latter with additional therapy. Acromegaly can be incidentally detected; hence, insulin-like growth factor-1 (IGF-1) measurement is indicated in all pituitary adenomas. Patients with persistent GH excess postoperatively have a greater long-term burden of comorbidities and require multimodality therapy. Biochemical control is attainable at pituitary centers of expertise with dedicated neurosurgeons and endocrinologists.

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