Abstrakt
Streszczenie
Akromegalia jest rzadką, przewlekłą chorobą powodowaną w większości przypadków przez guz przysadki wydzielający w nadmiarze hormon wzrostu (GH). Leczeniem pierwszego wyboru w akromegalii jest przezklinowa resekcja guza przysadki. Odsetek remisji pooperacyjnej waha się od 30-50% w przypadku makrogruczolaków do 70-90% w przypadku mikrogruczolaków. U pacjentów z czynną akromegalią po leczeniu operacyjnym zalecane jest leczenie farmakologiczne. Skuteczność leczenia farmakologicznego również jest zmienna w zależności od stosowanych leków.
Celem pracy jest podsumowanie aktualnej wiedzy na temat czynników przepowiadających remisję pooperacyjną oraz dobrą odpowiedź na leczenie farmakologiczne w akromegalii.
Czynniki wpływające na skuteczność leczenia operacyjnego, niezwiązane z guzem i pacjentem, to doświadczenie neurochirurga oraz stosowany przez niego sprzęt. Zarówno młodsi pacjenci jak i kobiety rzadziej osiągają remisję akromegalii po leczeniu operacyjnym. Pacjenci z niższymi stężeniami GH i insulinopodobnego czynnika wzrostu-1 (IGF-1) w momencie rozpoznania akromegalii, podczas doustnego testu obciążenia glukozą (OGTT) oraz po operacji mają większą szansę na uzyskanie remisji. Jednak niektóre prace nie potwierdzają takich związków. Pacjenci z większymi i bardziej inwazyjnymi guzami rzadziej osiągają remisję pooperacyjną. Obecność guzów hipointensywnych w T2 w obrazowaniu rezonansem magnetycznym wiąże się z lepszą odpowiedzią na analogi somatostatyny pierwszej generacji i na pasireotyd. Do czynników histo-patologicznych zwiększających szanse na remisję akromegalii należą cechy guza bogatoziarnistego, niższe wartości wskaźnika proliferacji komórkowej Ki-67, wysoka ekspresja receptorów dla somatostatyny (SSTRs) oraz wysoka ekspresja E-kadheryny.
Dokładna analiza wspomnianych czynników przepowiadających skuteczność leczenia akromegalii może być pomocna przy doborze spersonalizowanego leczenia akromegalii.
Bibliografia
References
1. Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020;105(4).
2. Frara S, Rodriguez-Carnero G, Formenti AM, Martinez-Olmos MA, Giustina A, Casanueva FF. Pituitary Tumors Centers of Excellence. Endocrinol Metab Clin North Am. 2020;49(3):553-64.
3. Bolanowski M, Ruchała M, Zgliczyński W, Kos-Kudła B, Hubalewska-Dydejczyk A, Lewiński A. Diagnostics and treatment of acromegaly - updated recommendations of the Polish Society of Endocrinology. Endokrynol Pol. 2019;70(1):2-18.
4. Katznelson L, Laws ER, Jr., Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-51.
5. Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2011;96(5):1327-35.
6. Colao A, Bronstein MD, Freda P, Gu F, Shen CC, Gadelha M, et al. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab. 2014;99(3):791-9.
7. Giustina A, Ambrosio MR, Beck Peccoz P, Bogazzi F, Cannavo S, De Marinis L, et al. Use of Pegvisomant in acromegaly. An Italian Society of Endocrinology guideline. J Endocrinol Invest. 2014;37(10):1017-30.
8. Guo X, Zhang R, Zhang D, Wang Z, Gao L, Yao Y, et al. Determinants of immediate and long-term remission after initial transsphenoidal surgery for acromegaly and outcome patterns during follow-up: a longitudinal study on 659 patients. J Neurosurg. 2022:1-11.
9. Araujo-Castro M, Pascual-Corrales E, Martínez-Vaello V, Baonza Saiz G, Quiñones de Silva J, Acitores Cancela A, et al. Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission. J Endocrinol Invest. 2021;44(1):183-93.
10. Durmuş ET, Atmaca A, Kefeli M, Çalışkan S, Mete O, Aslan K, et al. Age, GH/IGF-1 levels, tumor volume, T2 hypointensity, and tumor subtype rather than proliferation and invasion are all reliable predictors of biochemical response to somatostatin analogue therapy in patients with acromegaly: A clinicopathological study. Growth Horm IGF Res. 2022;67:101502.
11. Park SH, Ku CR, Moon JH, Kim EH, Kim SH, Lee EJ. Age- and Sex-Specific Differences as Predictors of Surgical Remission Among Patients With Acromegaly. J Clin Endocrinol Metab. 2018;103(3):909-16.
12. Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA, Jr. Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab. 2013;98(8):3190-8.
13. Taghvaei M, Sadrehosseini SM, Ardakani JB, Nakhjavani M, Zeinalizadeh M. Endoscopic Endonasal Approach to the Growth Hormone-Secreting Pituitary Adenomas: Endocrinologic Outcome in 68 Patients. World Neurosurg. 2018;117:e259-e68.
14. Minniti G, Jaffrain-Rea ML, Esposito V, Santoro A, Tamburrano G, Cantore G. Evolving criteria for post-operative biochemical remission of acromegaly: can we achieve a definitive cure? An audit of surgical results on a large series and a review of the literature. Endocr Relat Cancer. 2003;10(4):611-9.
15. Anthony JR, Alwahab UA, Kanakiya NK, Pontell DM, Veledar E, Oyesiku NM, et al. SIGNIFICANT ELEVATION OF GROWTH HORMONE LEVEL IMPACTS SURGICAL OUTCOMES IN ACROMEGALY. Endocr Pract. 2015;21(9):1001-9.
16. Sun H, Brzana J, Yedinak CG, Gultekin SH, Delashaw JB, Fleseriu M. Factors associated with biochemical remission after microscopic transsphenoidal surgery for acromegaly. J Neurol Surg B Skull Base. 2014;75(1):47-52.
17. Krzentowska-Korek A, Gołkowski F, Bałdys-Waligórska A, Hubalewska-Dydejczyk A. Efficacy and complications of neurosurgical treatment of acromegaly. Pituitary. 2011;14(2):157-62.
18. Bourdelot A, Coste J, Hazebroucq V, Gaillard S, Cazabat L, Bertagna X, et al. Clinical, hormonal and magnetic resonance imaging (MRI) predictors of transsphenoidal surgery outcome in acromegaly. Eur J Endocrinol. 2004;150(6):763-71.
19. Demir O, Gedik V, Corapcioglu D, Emral R, Unlu MA, Erdogan MF, et al. Improvement in remission rates of the first operation in acromegalic patients. Turk Neurosurg. 2012;22(5):645-50.
20. Shirvani M, Motiei-Langroudi R. Transsphenoidal surgery for growth hormone-secreting pituitary adenomas in 130 patients. World Neurosurg. 2014;81(1):125-30.
21. Jane JA, Jr., Starke RM, Elzoghby MA, Reames DL, Payne SC, Thorner MO, et al. Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab. 2011;96(9):2732-40.
22. Parkinson C, Ryder WD, Trainer PJ. The relationship between serum GH and serum IGF-I in acromegaly is gender-specific. J Clin Endocrinol Metab. 2001;86(11):5240-4.
23. Kim EH, Oh MC, Lee EJ, Kim SH. Predicting long-term remission by measuring immediate postoperative growth hormone levels and oral glucose tolerance test in acromegaly. Neurosurgery. 2012;70(5):1106-13; discussion 13.
24. Antunes X, Ventura N, Camilo GB, Wildemberg LE, Guasti A, Pereira PJM, et al. Predictors of surgical outcome and early criteria of remission in acromegaly. Endocrine. 2018;60(3):415-22.
25. Feelders RA, Bidlingmaier M, Strasburger CJ, Janssen JA, Uitterlinden P, Hofland LJ, et al. Postoperative evaluation of patients with acromegaly: clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels. J Clin Endocrinol Metab. 2005;90(12):6480-9.
26. Rotermund R, Burkhardt T, Rohani Z, Jung R, Aberle J, Flitsch J. Value of early postoperative random growth hormone levels and nadir growth hormone levels after oral glucose tolerance testing in acromegaly. Growth Horm IGF Res. 2018;41:64-70.
27. Biermasz NR, Pereira AM, Smit JW, Romijn JA, Roelfsema F. Intravenous octreotide test predicts the long term outcome of treatment with octreotide-long-acting repeatable in active acromegaly. Growth Horm IGF Res. 2005;15(3):200-6.
28. Halperin I, Nicolau J, Casamitjana R, Sesmilo G, Serra-Prat M, Palomera E, et al. A short acute octreotide test for response prediction of long-term treatment with somatostatin analogues in acromegalic patients. Horm Metab Res. 2008;40(6):422-6.
29. Halah FP, Elias LL, Martinelli CE, Jr., Castro M, Moreira AC. [Usefulness of subcutaneous or long-acting octreotide as a predictive test and in the treatment of acromegaly]. Arq Bras Endocrinol Metabol. 2004;48(2):245-52.
30. Karavitaki N, Botusan I, Radian S, Coculescu M, Turner HE, Wass JA. The value of an acute octreotide suppression test in predicting long-term responses to depot somatostatin analogues in patients with active acromegaly. Clin Endocrinol (Oxf). 2005;62(3):282-8.
31. Wang M, Shen M, He W, Yang Y, Liu W, Lu Y, et al. The value of an acute octreotide suppression test in predicting short-term efficacy of somatostatin analogues in acromegaly. Endocr J. 2016;63(9):819-34.
32. Hazer DB, Işık S, Berker D, Güler S, Gürlek A, Yücel T, et al. Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg. 2013;119(6):1467-77.
33. Starnoni D, Daniel RT, Marino L, Pitteloud N, Levivier M, Messerer M. Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis. Acta Neurochir (Wien). 2016;158(11):2109-21.
34. Sarkar S, Rajaratnam S, Chacko G, Chacko AG. Endocrinological outcomes following endoscopic and microscopic transsphenoidal surgery in 113 patients with acromegaly. Clin Neurol Neurosurg. 2014;126:190-5.
35. Trepp R, Stettler C, Zwahlen M, Seiler R, Diem P, Christ ER. Treatment outcomes and mortality of 94 patients with acromegaly. Acta Neurochir (Wien). 2005;147(3):243-51; discussion 50-1.
36. Tomasik A, Stelmachowska-Banaś M, Maksymowicz M, Czajka-Oraniec I, Raczkiewicz D, Zieliński G, et al. Clinical, hormonal and pathomorphological markers of somatotroph pituitary neuroendocrine tumors predicting the treatment outcome in acromegaly. Front Endocrinol (Lausanne). 2022;13:957301.
37. Haliloglu O, Kuruoglu E, Ozkaya HM, Keskin FE, Gunaldi O, Oz B, et al. Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience. World Neurosurg. 2016;88:270-6.
38. Buliman A, Tataranu LG, Ciubotaru V, Cazac TL, Dumitrache C. The multimodal management of GH-secreting pituitary adenomas: predictive factors, strategies and outcomes. J Med Life. 2016;9(2):187-92.
39. Kim MS, Jang HD, Kim OL. Surgical results of growth hormone-secreting pituitary adenoma. J Korean Neurosurg Soc. 2009;45(5):271-4.
40. Potorac I, Petrossians P, Daly AF, Schillo F, Ben Slama C, Nagi S, et al. Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr Relat Cancer. 2015;22(2):169-77.
41. Potorac I, Petrossians P, Daly AF, Alexopoulou O, Borot S, Sahnoun-Fathallah M, et al. T2-weighted MRI signal predicts hormone and tumor responses to somatostatin analogs in acromegaly. Endocr Relat Cancer. 2016;23(11):871-81.
42. Coopmans EC, Schneiders JJ, El-Sayed N, Erler NS, Hofland LJ, van der Lely AJ, et al. T2-signal intensity, SSTR expression, and somatostatin analogs efficacy predict response to pasireotide in acromegaly. Eur J Endocrinol. 2020;182(6):595-605.
43. Dehghani M, Davoodi Z, Bidari F, Moghaddam AM, Khalili D, Bahrami-Motlagh H, et al. Association of different pathologic subtypes of growth hormone producing pituitary adenoma and remission in acromegaly patients: a retrospective cohort study. BMC Endocr Disord. 2021;21(1):186.
44. Kiseljak-Vassiliades K, Carlson NE, Borges MT, Kleinschmidt-DeMasters BK, Lillehei KO, Kerr JM, et al. Growth hormone tumor histological subtypes predict response to surgical and medical therapy. Endocrine. 2015;49(1):231-41.
45. Iacovazzo D, Carlsen E, Lugli F, Chiloiro S, Piacentini S, Bianchi A, et al. Factors predicting pasireotide responsiveness in somatotroph pituitary adenomas resistant to first-generation somatostatin analogues: an immunohistochemical study. Eur J Endocrinol. 2016;174(2):241-50.
46. Kasuki L, Wildemberg LE, Neto LV, Marcondes J, Takiya CM, Gadelha MR. Ki-67 is a predictor of acromegaly control with octreotide LAR independent of SSTR2 status and relates to cytokeratin pattern. Eur J Endocrinol. 2013;169(2):217-23.
47. Sarkar S, Chacko AG, Chacko G. An analysis of granulation patterns, MIB-1 proliferation indices and p53 expression in 101 patients with acromegaly. Acta Neurochir (Wien). 2014;156(12):2221-30; discussion 30.
48. Alimohamadi M, Ownagh V, Mahouzi L, Ostovar A, Abbassioun K, Amirjmshidi A. The impact of immunohistochemical markers of Ki-67 and p53 on the long-term outcome of growth hormone-secreting pituitary adenomas: A cohort study. Asian J Neurosurg. 2014;9(3):130-6.
49. Fusco A, Zatelli MC, Bianchi A, Cimino V, Tilaro L, Veltri F, et al. Prognostic significance of the Ki-67 labeling index in growth hormone-secreting pituitary adenomas. J Clin Endocrinol Metab. 2008;93(7):2746-50.
50. Casarini AP, Jallad RS, Pinto EM, Soares IC, Nonogaki S, Giannella-Neto D, et al. Acromegaly: correlation between expression of somatostatin receptor subtypes and response to octreotide-lar treatment. Pituitary. 2009;12(4):297-303.
51. Wildemberg LE, Neto LV, Costa DF, Nasciuti LE, Takiya CM, Alves LM, et al. Low somatostatin receptor subtype 2, but not dopamine receptor subtype 2 expression predicts the lack of biochemical response of somatotropinomas to treatment with somatostatin analogs. J Endocrinol Invest. 2013;36(1):38-43.
52. Rick J, Jahangiri A, Flanigan PM, Chandra A, Kunwar S, Blevins L, et al. Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes. J Neurosurg. 2018;131(1):147-53.
53. De Marinis L, Zuppi P, Valle D, Mancini A, Bianchi A, Lauriola L, et al. A retrospective hormonal and immunohistochemical evaluation of 47 acromegalic patients: prognostic value of preoperative plasma prolactin. Horm Metab Res. 2002;34(3):137-43.
54. Kreutzer J, Vance ML, Lopes MB, Laws ER, Jr. Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab. 2001;86(9):4072-7.
55. Wang M, Mou C, Jiang M, Han L, Fan S, Huan C, et al. The characteristics of acromegalic patients with hyperprolactinemia and the differences in patients with merely GH-secreting adenomas: clinical analysis of 279 cases. Eur J Endocrinol. 2012;166(5):797-802.
56. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol. 2005;152(3):379-87.
57. Venegas-Moreno E, Flores-Martinez A, Dios E, Vazquez-Borrego MC, Ibañez-Costa A, Madrazo-Atutxa A, et al. E-cadherin expression is associated with somatostatin analogue response in acromegaly. J Cell Mol Med. 2019;23(5):3088-96.
58. Fougner SL, Lekva T, Borota OC, Hald JK, Bollerslev J, Berg JP. The expression of E-cadherin in somatotroph pituitary adenomas is related to tumor size, invasiveness, and somatostatin analog response. J Clin Endocrinol Metab. 2010;95(5):2334-42.
59. Soukup J, Hornychova H, Manethova M, Michalova K, Michnova L, Popovska L, et al. Predictive and prognostic significance of tumour subtype, SSTR1-5 and e-cadherin expression in a well-defined cohort of patients with acromegaly. J Cell Mol Med. 2021;25(5):2484-92.
60. Phan K, Xu J, Reddy R, Kalakoti P, Nanda A, Fairhall J. Endoscopic Endonasal versus Microsurgical Transsphenoidal Approach for Growth Hormone-Secreting Pituitary Adenomas-Systematic Review and Meta-Analysis. World Neurosurg. 2017;97:398-406.
61. Agrawal N, Ioachimescu AG. Prognostic factors of biochemical remission after transsphenoidal surgery for acromegaly: a structured review. Pituitary. 2020;23(5):582-94.
1. Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020;105(4).
2. Frara S, Rodriguez-Carnero G, Formenti AM, Martinez-Olmos MA, Giustina A, Casanueva FF. Pituitary Tumors Centers of Excellence. Endocrinol Metab Clin North Am. 2020;49(3):553-64.
3. Bolanowski M, Ruchała M, Zgliczyński W, Kos-Kudła B, Hubalewska-Dydejczyk A, Lewiński A. Diagnostics and treatment of acromegaly - updated recommendations of the Polish Society of Endocrinology. Endokrynol Pol. 2019;70(1):2-18.
4. Katznelson L, Laws ER, Jr., Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-51.
5. Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a meta-analysis. J Clin Endocrinol Metab. 2011;96(5):1327-35.
6. Colao A, Bronstein MD, Freda P, Gu F, Shen CC, Gadelha M, et al. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab. 2014;99(3):791-9.
7. Giustina A, Ambrosio MR, Beck Peccoz P, Bogazzi F, Cannavo S, De Marinis L, et al. Use of Pegvisomant in acromegaly. An Italian Society of Endocrinology guideline. J Endocrinol Invest. 2014;37(10):1017-30.
8. Guo X, Zhang R, Zhang D, Wang Z, Gao L, Yao Y, et al. Determinants of immediate and long-term remission after initial transsphenoidal surgery for acromegaly and outcome patterns during follow-up: a longitudinal study on 659 patients. J Neurosurg. 2022:1-11.
9. Araujo-Castro M, Pascual-Corrales E, Martínez-Vaello V, Baonza Saiz G, Quiñones de Silva J, Acitores Cancela A, et al. Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission. J Endocrinol Invest. 2021;44(1):183-93.
10. Durmuş ET, Atmaca A, Kefeli M, Çalışkan S, Mete O, Aslan K, et al. Age, GH/IGF-1 levels, tumor volume, T2 hypointensity, and tumor subtype rather than proliferation and invasion are all reliable predictors of biochemical response to somatostatin analogue therapy in patients with acromegaly: A clinicopathological study. Growth Horm IGF Res. 2022;67:101502.
11. Park SH, Ku CR, Moon JH, Kim EH, Kim SH, Lee EJ. Age- and Sex-Specific Differences as Predictors of Surgical Remission Among Patients With Acromegaly. J Clin Endocrinol Metab. 2018;103(3):909-16.
12. Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA, Jr. Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab. 2013;98(8):3190-8.
13. Taghvaei M, Sadrehosseini SM, Ardakani JB, Nakhjavani M, Zeinalizadeh M. Endoscopic Endonasal Approach to the Growth Hormone-Secreting Pituitary Adenomas: Endocrinologic Outcome in 68 Patients. World Neurosurg. 2018;117:e259-e68.
14. Minniti G, Jaffrain-Rea ML, Esposito V, Santoro A, Tamburrano G, Cantore G. Evolving criteria for post-operative biochemical remission of acromegaly: can we achieve a definitive cure? An audit of surgical results on a large series and a review of the literature. Endocr Relat Cancer. 2003;10(4):611-9.
15. Anthony JR, Alwahab UA, Kanakiya NK, Pontell DM, Veledar E, Oyesiku NM, et al. SIGNIFICANT ELEVATION OF GROWTH HORMONE LEVEL IMPACTS SURGICAL OUTCOMES IN ACROMEGALY. Endocr Pract. 2015;21(9):1001-9.
16. Sun H, Brzana J, Yedinak CG, Gultekin SH, Delashaw JB, Fleseriu M. Factors associated with biochemical remission after microscopic transsphenoidal surgery for acromegaly. J Neurol Surg B Skull Base. 2014;75(1):47-52.
17. Krzentowska-Korek A, Gołkowski F, Bałdys-Waligórska A, Hubalewska-Dydejczyk A. Efficacy and complications of neurosurgical treatment of acromegaly. Pituitary. 2011;14(2):157-62.
18. Bourdelot A, Coste J, Hazebroucq V, Gaillard S, Cazabat L, Bertagna X, et al. Clinical, hormonal and magnetic resonance imaging (MRI) predictors of transsphenoidal surgery outcome in acromegaly. Eur J Endocrinol. 2004;150(6):763-71.
19. Demir O, Gedik V, Corapcioglu D, Emral R, Unlu MA, Erdogan MF, et al. Improvement in remission rates of the first operation in acromegalic patients. Turk Neurosurg. 2012;22(5):645-50.
20. Shirvani M, Motiei-Langroudi R. Transsphenoidal surgery for growth hormone-secreting pituitary adenomas in 130 patients. World Neurosurg. 2014;81(1):125-30.
21. Jane JA, Jr., Starke RM, Elzoghby MA, Reames DL, Payne SC, Thorner MO, et al. Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab. 2011;96(9):2732-40.
22. Parkinson C, Ryder WD, Trainer PJ. The relationship between serum GH and serum IGF-I in acromegaly is gender-specific. J Clin Endocrinol Metab. 2001;86(11):5240-4.
23. Kim EH, Oh MC, Lee EJ, Kim SH. Predicting long-term remission by measuring immediate postoperative growth hormone levels and oral glucose tolerance test in acromegaly. Neurosurgery. 2012;70(5):1106-13; discussion 13.
24. Antunes X, Ventura N, Camilo GB, Wildemberg LE, Guasti A, Pereira PJM, et al. Predictors of surgical outcome and early criteria of remission in acromegaly. Endocrine. 2018;60(3):415-22.
25. Feelders RA, Bidlingmaier M, Strasburger CJ, Janssen JA, Uitterlinden P, Hofland LJ, et al. Postoperative evaluation of patients with acromegaly: clinical significance and timing of oral glucose tolerance testing and measurement of (free) insulin-like growth factor I, acid-labile subunit, and growth hormone-binding protein levels. J Clin Endocrinol Metab. 2005;90(12):6480-9.
26. Rotermund R, Burkhardt T, Rohani Z, Jung R, Aberle J, Flitsch J. Value of early postoperative random growth hormone levels and nadir growth hormone levels after oral glucose tolerance testing in acromegaly. Growth Horm IGF Res. 2018;41:64-70.
27. Biermasz NR, Pereira AM, Smit JW, Romijn JA, Roelfsema F. Intravenous octreotide test predicts the long term outcome of treatment with octreotide-long-acting repeatable in active acromegaly. Growth Horm IGF Res. 2005;15(3):200-6.
28. Halperin I, Nicolau J, Casamitjana R, Sesmilo G, Serra-Prat M, Palomera E, et al. A short acute octreotide test for response prediction of long-term treatment with somatostatin analogues in acromegalic patients. Horm Metab Res. 2008;40(6):422-6.
29. Halah FP, Elias LL, Martinelli CE, Jr., Castro M, Moreira AC. [Usefulness of subcutaneous or long-acting octreotide as a predictive test and in the treatment of acromegaly]. Arq Bras Endocrinol Metabol. 2004;48(2):245-52.
30. Karavitaki N, Botusan I, Radian S, Coculescu M, Turner HE, Wass JA. The value of an acute octreotide suppression test in predicting long-term responses to depot somatostatin analogues in patients with active acromegaly. Clin Endocrinol (Oxf). 2005;62(3):282-8.
31. Wang M, Shen M, He W, Yang Y, Liu W, Lu Y, et al. The value of an acute octreotide suppression test in predicting short-term efficacy of somatostatin analogues in acromegaly. Endocr J. 2016;63(9):819-34.
32. Hazer DB, Işık S, Berker D, Güler S, Gürlek A, Yücel T, et al. Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg. 2013;119(6):1467-77.
33. Starnoni D, Daniel RT, Marino L, Pitteloud N, Levivier M, Messerer M. Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis. Acta Neurochir (Wien). 2016;158(11):2109-21.
34. Sarkar S, Rajaratnam S, Chacko G, Chacko AG. Endocrinological outcomes following endoscopic and microscopic transsphenoidal surgery in 113 patients with acromegaly. Clin Neurol Neurosurg. 2014;126:190-5.
35. Trepp R, Stettler C, Zwahlen M, Seiler R, Diem P, Christ ER. Treatment outcomes and mortality of 94 patients with acromegaly. Acta Neurochir (Wien). 2005;147(3):243-51; discussion 50-1.
36. Tomasik A, Stelmachowska-Banaś M, Maksymowicz M, Czajka-Oraniec I, Raczkiewicz D, Zieliński G, et al. Clinical, hormonal and pathomorphological markers of somatotroph pituitary neuroendocrine tumors predicting the treatment outcome in acromegaly. Front Endocrinol (Lausanne). 2022;13:957301.
37. Haliloglu O, Kuruoglu E, Ozkaya HM, Keskin FE, Gunaldi O, Oz B, et al. Multidisciplinary Approach for Acromegaly: A Single Tertiary Center's Experience. World Neurosurg. 2016;88:270-6.
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