Various methods for determining somatotropic hormone in the early postoperative period to predict acromegaly remission after transsphenoidal adenomectomy
Aim: to study the information value of determining the somatotropic hormone (STH) basal level 24 hours after surgery and its level in the oral glucose tolerance test (OGTT) 14 days after surgery to predict the outcomes of acromegaly surgery. Patients and Methods: 39 patients with newly diagnosed acromegaly underwent a single-center cohort prospective surveillance study. Pituitary microadenoma was detected in 8 patients, macroadenoma - in 31 patients. All patients underwent a transsphenoidal adenomectomy (TSA) performed by a single neurosurgeon. 24 hours after the operation, the STH basal level in the blood was determined. Two weeks after the TSA, the OGTT was conducted to determine the STH level. The surgical treatment efficacy of acromegaly was evaluated after 12 months. The values of STH and insulin-like growth factor-1 (IGF-1) (that meet the Acromegaly Consensus Group criteria of 2010) were taken under the biochemical remission of acromegaly. Results: 12 months after surgery, 18 of 39 patients achieved acromegaly remission. Basal STH level 24 hours after TSA <1.30 ng/ml was associated with acromegaly remission with sensitivity of 93.7% (95% CI 81.1-98.3%) and specificity of 83.5% (95% CI 60.1-93.8%). The minimum STH level in OGTT <1.0 ng/ml 14 days after TSA was associated with the subsequent development of acromegaly remission with sensitivity of 85.7% (95% CI 60.1-97.5%) and specificity of 80.0% (95% CI 54.8-92.9%). Conclusion: STH level in the early postoperative period can be used to predict the TSA outcomes. Low basal STH level 24 hours after surgery is a better predictor of achieving acromegaly remission than STH levels inhibition in the OGTT by 14th day after TSA. The data obtained can be taken into account when making a decision about the patient’s management after TSA. It is necessary to confirm the identified results in further studies with a longer duration and number of observations.