Somatotroph adenoma outcome [Neurosurgery Wiki]

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====== Somatotroph adenoma outcome ======

Somatotroph [[pituitary neuroendocrine tumor]], ([[GH]] producing [[adenoma]]s, somatotropinomas) is an insidious disease with persistent hypersecretion of [[growth hormone]] and [[insulin-like growth factor 1]], causing increased morbidity and mortality. 


[[Growth hormone]]-secreting functioning [[pituitary neuroendocrine tumor]] (GHPA) is a rare, chronic, systemic disease that is associated with premature death and significant morbidity
((Ayuk J, Clayton RN, Holder G, Sheppard MC, Stewart PM, Bates AS. Growth hormone and pituitary radiotherapy, but not serum insulin-like growth factor-I concentrations, predict excess mortality in patients with acromegaly. J Clin Endocrinol Metab. 2004;89:1613–7.)).
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Cavernous sinus (CS) invasion is an unfavorable factor hindering remission of [[Growth hormone secreting pituitary neuroendocrine tumor]].

The [[Standardized mortality ratio]] (the ratio of observed mortality in the acromegalic population to expected mortality in the general population) ranged from 1.2 to 3.3. If left untreated, patients with acromegaly can die approximately 10 years earlier than the healthy subjects. According to prior studies, approximately 60, 25 and 15% of the patients die from cardiovascular disease, respiratory complications and cancer, respectively
((Chanson P, Salenave S, Kamenicky P, Cazabat L, Young J. Pituitary tumours: Acromegaly. Best Pract Res Clin Endocrinol Metab. 2009;23:555–74.))
((Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary. 1999;2:29–41.)).


Control of serum GH and insulin-like growth factor (IGF) 1 hypersecretion by surgery or pharmacotherapy can decrease morbidity. 

Remission rates for micro- and macroadenomas were 81.8% and 45.8%, respectively. Patients of older age, with a smaller tumor, lower Knosp grade, lower preoperative GH, and insulinlike growth factor 1 levels were more likely to achieve remission. Remission rate decreased significantly with repeat surgeries. Those patients with adenomas that stained positive for somatostatin receptor subtype 2A were less likely to experience tumor recurrence and more likely to respond to medical treatment with persistent or elevated GH hypersecretion
((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 Feb;75(1):47-52. doi:
10.1055/s-0033-1354578. Epub 2013 Sep 9. PubMed PMID: 24498589; PubMed Central
PMCID: PMC3912146.)).


Each of the [[biomarker]]s, Ki-67 and p53, along with patient's age and mixed GH-prolactin secretion showed a kind of correlation with each of aspects of the clinical, hormonal and radiologic outcome of GH-secreting pituitary neuroendocrine tumors in the series of Alimohamadi et al.
((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 neuroendocrine tumors: A cohort study. Asian J
Neurosurg. 2014 Jul-Sep;9(3):130-6. doi: 10.4103/1793-5482.142732. PubMed PMID:
25685203; PubMed Central PMCID: PMC4323896.)).

===== References =====