Early predictors of remission in acromegaly patients after pure endoscopic endonasal transsphenoidal surgery

Surgery is the first line treatment in acromegaly but it takes months to confirm remission. It is crucial to determine remission early in order to inform the patient and plan further treatment options. We aimed to evaluate the predictors of remission at the early phase after endoscopic endonasal pituitary surgery in acromegaly patients. Methods: Fifty-four GH-adenoma patients operated via pure endoscopic endonasal approach were analysed in this observational study. We compared the basic clinical, radiological characteristics, and the preoperative and postoperative hormone levels in terms of remission according to current guidelines. Results: The surgical remission rate was 61.1%. When the patients were compared according to surgical remission, the age, gender, and immunohistochemical granulation type were non-significant, while diabetes mellitus was more common (55.6% vs 44.4%), the preoperative tumor volume (1.2  0.9 cm3 vs 4.1  4.2 cm3), postoperative GH and IGF-1 levels were higher in the non-remission group (p0.05). We defined a number of cut-off values of both GH and IGF-1 levels to predict remission at the postoperative phase. Age standardized regression analyses showed that postoperative day 1 (POD-1) GH levels (OR:8.9; 95%CI:1.99-40.0, p=0.004) and tumor volume (OR:3.14; 95%CI:1.09-9.0, p=0.034) were found to be significant independent predictors for remission. Conclusion: We demonstrated that tumor volume and POD1 GH levels are independent predictors of remission in acromegaly patients operated via pure endoscopic endonasal technique and may be used as an early marker of remission and this may lead to taking adjuvant medical therapies early into account to improve prognosis.