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dc.contributor.authorHazer, Derya Burcu
dc.contributor.authorIşık, Serhat
dc.contributor.authorBerker, Dilek
dc.contributor.authorGüler, Serdar
dc.contributor.authorGürlek, Alper
dc.contributor.authorYücel, Taşkın
dc.contributor.authorBerker, Mustafa
dc.date.accessioned2020-11-20T16:19:07Z
dc.date.available2020-11-20T16:19:07Z
dc.date.issued2013
dc.identifier.issn0022-3085
dc.identifier.issn1933-0693
dc.identifier.urihttps://doi.org/10.3171/2013.8.JNS13224
dc.identifier.urihttps://hdl.handle.net/20.500.12809/3698
dc.descriptionWOS: 000327367200016en_US
dc.descriptionPubMed ID: 24074496en_US
dc.description.abstractObject. Acromegaly is a disease that has significant morbidity and mortality related to high levels of growth hormone (GH) and insulin-like growth factor I (IGF-I), and is usually caused by pituitary adenomas. The goal in this study was to investigate the role of endoscopic transsphenoidal surgery and surgical experience in the treatment of OH adenoma cases in relation to surgical results and hormonal cure rates, and to perform a review of the literature. Methods. The authors present a retrospective analysis of 214 GH adenoma cases. Restoration of IGF-I levels to normal for age and sex, suppression of GH levels below 0.4 mu g/L on the oral glucose tolerance test, and demonstration of the total removal of the tumor on MRI studies obtained after administration of contrast material at the 3-month postoperative follow-up visit were the criteria for cure. Results. In total 214 patients with a mean age of 41.9 +/- 12 years (range 17-75 years) and a male/female ratio of 106/108 were enrolled in the study. Cure was achieved in 134 (62.6%) of 214 patients. One hundred sixty-nine patients were primary cases, and of these 109 (64.5%) were cured, whereas 61 patients were previously operated cases and of these 25 (41%) were cured. With a 51.1% decrease in the 1st month postoperatively, IGF-I levels were found to be predictive of cure (74.4% sensitivity and 73.7% specificity). Cut-off values for OH levels in predicting cure for the 1st day, 1st week, and 1st month postoperatively were 2.33, 2.05, and 2.25 mu g/L, respectively. The cut-off value for surgical experience was 57 for primary surgeries (58.5% cure rate before this cut-off value compared with 72.6% after it; p = 0.025) and 108 for all operations (45.8% vs 79.4%, p = 0.037). Although 28 patients were found to be in remission according to the criteria in 2000, they were not in remission according to the new consensus criteria. Nine of these cases (32.1%) had random OH levels < 1 mu g/L at the 1-year follow-up. The 1-year IGF-I and GH levels in these 28 patients showed no significant difference when compared with the cases defined as cured according to the current criteria. Conclusions. In acromegaly treatment, transsphenoidal endoscopic surgery performed by an expert senior surgeon and increased surgical experience are important for higher cure rates. Random OH levels < 2.33 mu g/L after the 1st day postoperatively and a> 50% decrease in IGF-I levels after the 1st month postoperatively are predictive of cure. Moreover, there is no urgency for additional therapy in patients with OH levels of 0.4-1 mu g/L and MRI sequences showing no tumor at the 3-month follow-up, because for these cases remission can be achieved at the 1-year follow-up.en_US
dc.item-language.isoengen_US
dc.publisherAmer Assoc Neurological Surgeonsen_US
dc.item-rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectAcromegalyen_US
dc.subjectEndoscopic Pituitary Surgeryen_US
dc.subjectPituitary Adenomaen_US
dc.subjectRemissionen_US
dc.titleTreatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteriaen_US
dc.item-typearticleen_US
dc.contributor.departmentMÜ, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümüen_US
dc.contributor.institutionauthorHazer, Derya Burcu
dc.identifier.doi10.3171/2013.8.JNS13224
dc.identifier.volume119en_US
dc.identifier.issue6en_US
dc.identifier.startpage1467en_US
dc.identifier.endpage1477en_US
dc.relation.journalJournal of Neurosurgeryen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US


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