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September 22, 1975, Vol 233, No. 12 >
ARTICLE | September 22, 1975

Acromegaly: Title and subTitle BreakTreatment by Transsphenoidal Microsurgery FREE

Richard L. Atkinson, MD; Donald P. Becker, MD; Albert N. Martins, MD; Marcus Schaaf, MD; Richard C. Dimond, MD; Leonard Wartofsky, MD; Jerry M. Earll, MD
[+] Author Affiliations

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Reprint requests to Department of Endocrinology and Metabolism, Walter Reed Army Institute of Research, Washington, DC 20012 (Dr. Earll).


JAMA. 1975;233(12):1279-1283. doi:10.1001/jama.1975.03260120041018
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References

Serum growth hormone levels, thyroid function, and adrenal function were measured before and after surgery in 16 of 17 acromegalic patients undergoing transnasal transsphenoidal microsurgery of the pituitary. Thirteen patients have been followed up for 12 to 24 months; three patients have been followed up for three to six months. Serum growth hormone levels decreased to less than 5 ng/ml in seven of nine previously untreated patients; thyroid and adrenal function were preserved in eight of these nine patients. In seven patients treated previously by other modes of therapy, growth hormone levels after transsphenoidal surgery decreased to less than 5 ng/ml in three, to between 5 and 10 ng/ml in three, and from 98 to 41 ng/ml in one. Preoperative adrenal function was normal in six of these seven patients and was preserved in four; thyroid function was normal in five patients preoperatively and was preserved in three.

Transsphenoidal microsurgery appears to offer an effective means of lowering growth hormone levels and a possibility of preserving any remaining normal pituitary function. It may be considered for initial treatment in selected patients in whom more rapid arrest of acromegaly is indicated.

(JAMA 233:1279-1283, 1975)

REFERENCES

1 +
Wright AD, Hill DM, Lowry C, et all:  Mortality in acromegaly . Quart J Med 39:1-16, 1970;.
2 +
Roth J, Gorden P, Brace K:  Efficacy of conventional pituitary irradiation in acromegaly . N Engl J Med 282:1385-1391, 1970;.
3 +
Lawrence AM, Pinsky SM, Goldfine ID:  Conventional radiation therapy in acromegaly: A review and reassessment . Arch Intern Med 128:369-377, 1971;.
4 +
Lawrence JH, Tobias CA, Linfoot JA, et al:  Successful treatment of acromegaly: Metabolic and clinical studies in 145 patients . J Clin Endocrinol 31:180-198, 1970;.
5 +
Kjellberg RN, Shintani A, Frantz AG, et al:  Proton-beam therapy in acromegaly . N Engl J Med 278:689-695, 1968;.
6 +
Wright AD, Hartog M, Palter H, et al:  The use of yttrium 90 implantation in the treatment of acromegaly . Proc Roy Soc Med 63:221-223, 1970;.
7 +
Adams JE, Seymour RJ, Earll JM, et al:  Transsphenoidal cryohypophysectomy in acromegaly . J Neurosurg 28:100-104, 1968;.
8 +
Maddy JA, Winternitz WW, Norrel H, et al:  Acromegaly: Treatment by cryoablation . Ann Intern Med 71:497-505, 1969;.
9 +
Jacobs HS, Greenwood FC, Nabarro JDN:  Changes in plasma growth hormone levels after surgical treatment of acromegaly . Proc Roy Soc Med 63:223-224, 1970;.
10 +
Lawrence AM, Kirsteins L:  Progestins in the medical management of active acromegaly . J Clin Endocrinol 30:646-652, 1970;.
11 +
Kolodny HD, Sherman LS, Singh A, et al:  Acromegaly treated with chlorpromazine . N Engl J Med 284:819-822, 1971;.
12 +
Malarkey WB, Daughaday WH:  Variable response to plasma GH in acromegalic patients treated with medroxyprogesterone acetate . J Clin Endocrinol 33:424-431, 1971;.
13 +
Jackson IMD, Ormston BJ:  Lack of beneficial response of serum GH in acromegalic patients treated with medroxyprogesterone acetate (MPA) . J Clin Endocrinol 35:413-415, 1972;.
14 +
Atkinson RL, Dimond RC, Howard WJ, et al:  Unsuccessful treatment of acromegaly with medroxyprogesterone acetate . Acta Endocrinol 77:19-25, 1974;.
15 +
Dimond RC, Brammer SR, Atkinson RL Jr, et al:  Chlorpromazine treatment and growth hormone secretory responses in acromegaly . J Clin Endocrinol 36:1189-1195, 1973;.
16 +
Hardy J, Wigser SM:  Transsphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control . J Neurosurg 23:616-619, 1965;.
17 +
Hardy J:  Transsphenoidal hypohysectomy . J Neurosurg 34:582-594, 1971;.
18 +
Bateman GH:  Transsphenoidal hypophysectomy . J Laryngol Otol 76:442-455, 1962;.
19 +
Montgomery WW:  Transethmoidosphenoidal hypophysectomy with septal mucosal flap . Arch Otolaryngol 78:68-77, 1963;.
20 +
Siren HJ, Litzow TJ:  Removal of certain hypophyseal tumors by the transantral-sphenoidal route . J Neurosurg 23:606-611, 1965;.
21 +
Rohde W, Knappe G, Mennig H, et al:  Assessment of somatotrophic hypophyseal function in acromegalic patients by estimation of serum growth hormone before and after surgical treatment . Hormone Res 4:129-140, 1973;.
22 +
Hardy J:  Transsphenoidal surgery of hypersecreting pituitary tumors , in Kohler PO, Ross GT (eds): The Diagnosis and Treatment of Pituitary Tumors . Amsterdam, Excerpta Medica, 1973;, pp 179-194.
23 +
Samaan NA, Leavens ME, Jesse RH Jr:  Serum growth hormone and prolactin response to thyrotropin-releasing hormone in patients with acromegaly before and after surgery . J Clin Endocrinol 38:957-963, 1974;.
24 +
Cryer PE, Daughaday WH:  Regulation of growth hormone secretion in acromegaly . J Clin Endocrinol 29:386-393, 1969;.
25 +
Glick SM, Roth J, Yalow RS, et al:  Immunoassay of human growth hormone in plasma . Nature 199:784-787, 1963;.
26 +
Catt K, Tregfar GW:  Solid-phase radioimmunoassay in antibody-coated tubes . Science 158:1570-1572, 1967;.
27 +
Earll JM, Sparks LL, Forsham PH:  Glucose suppression of serum growth hormone in the diagnosis of acromegaly . JAMA 201:628-630, 1967;.
28 +
Murphy BEP, Pattee CJ:  Determination of thyroxine utilizing the property of protein binding . J Clin Endocrinol 24:187-196, 1964;.
29 +
Noel GL, Dimond RC, Wartofsky L, et al:  Studies of prolactin and TSH secretion by continuous infusion of small amounts of thyrotropin-releasing-hormone (TRH) . J Clin Endocrinol 39:6-17, 1974;.
30 +
Porter CC, Silber RH:  A quantitative color reaction for cortisone and related 17, 21 dihydroxy-20 ketosteroids . J Biol Chem 185:201-207, 1950;.
31 +
Liddle GW, Estep HL, Kendall JW, et al:  Clinical application of a new test of pituitary reserve . J Clin Endocrinol 19:875-894, 1959;.
32 +
Gorden P, Roth J:  The treatment of acromegaly by conventional pituitary irradiation , in Proceedings of a Conference on Diagnosis and Treatment of Pituitary Tumors, Bethesda, Md, Jan 15-17, 1973 . International Congress series 303, Amsterdam, Excerpta Medica, 1974;, pp 230-233.
33 +
Levin SR, Hofeldt FD, Schneider V, et al:  Cryohypophysectomy for acromegaly: Factors associated with altered endocrine function and carbohydrate metabolism . Am J Med 57:526-535, 1974;.
34 +
Pearson OH:  Acromegaly , in Conn HF (ed): Current Therapy. Philadelphia, WB Saunders Co, 1974;, pp 464-466.
35 +
Williams RA, Jacobs HS, Kurtz AB, et al:  The treatment of acromegaly with special reference to trans-sphenoidal hypophysectomy . Quart J Med 44:79-98, 1975;.

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1 +
Wright AD, Hill DM, Lowry C, et all:  Mortality in acromegaly . Quart J Med 39:1-16, 1970;.
2 +
Roth J, Gorden P, Brace K:  Efficacy of conventional pituitary irradiation in acromegaly . N Engl J Med 282:1385-1391, 1970;.
3 +
Lawrence AM, Pinsky SM, Goldfine ID:  Conventional radiation therapy in acromegaly: A review and reassessment . Arch Intern Med 128:369-377, 1971;.
4 +
Lawrence JH, Tobias CA, Linfoot JA, et al:  Successful treatment of acromegaly: Metabolic and clinical studies in 145 patients . J Clin Endocrinol 31:180-198, 1970;.
5 +
Kjellberg RN, Shintani A, Frantz AG, et al:  Proton-beam therapy in acromegaly . N Engl J Med 278:689-695, 1968;.
6 +
Wright AD, Hartog M, Palter H, et al:  The use of yttrium 90 implantation in the treatment of acromegaly . Proc Roy Soc Med 63:221-223, 1970;.
7 +
Adams JE, Seymour RJ, Earll JM, et al:  Transsphenoidal cryohypophysectomy in acromegaly . J Neurosurg 28:100-104, 1968;.
8 +
Maddy JA, Winternitz WW, Norrel H, et al:  Acromegaly: Treatment by cryoablation . Ann Intern Med 71:497-505, 1969;.
9 +
Jacobs HS, Greenwood FC, Nabarro JDN:  Changes in plasma growth hormone levels after surgical treatment of acromegaly . Proc Roy Soc Med 63:223-224, 1970;.
10 +
Lawrence AM, Kirsteins L:  Progestins in the medical management of active acromegaly . J Clin Endocrinol 30:646-652, 1970;.
11 +
Kolodny HD, Sherman LS, Singh A, et al:  Acromegaly treated with chlorpromazine . N Engl J Med 284:819-822, 1971;.
12 +
Malarkey WB, Daughaday WH:  Variable response to plasma GH in acromegalic patients treated with medroxyprogesterone acetate . J Clin Endocrinol 33:424-431, 1971;.
13 +
Jackson IMD, Ormston BJ:  Lack of beneficial response of serum GH in acromegalic patients treated with medroxyprogesterone acetate (MPA) . J Clin Endocrinol 35:413-415, 1972;.
14 +
Atkinson RL, Dimond RC, Howard WJ, et al:  Unsuccessful treatment of acromegaly with medroxyprogesterone acetate . Acta Endocrinol 77:19-25, 1974;.
15 +
Dimond RC, Brammer SR, Atkinson RL Jr, et al:  Chlorpromazine treatment and growth hormone secretory responses in acromegaly . J Clin Endocrinol 36:1189-1195, 1973;.
16 +
Hardy J, Wigser SM:  Transsphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control . J Neurosurg 23:616-619, 1965;.
17 +
Hardy J:  Transsphenoidal hypohysectomy . J Neurosurg 34:582-594, 1971;.
18 +
Bateman GH:  Transsphenoidal hypophysectomy . J Laryngol Otol 76:442-455, 1962;.
19 +
Montgomery WW:  Transethmoidosphenoidal hypophysectomy with septal mucosal flap . Arch Otolaryngol 78:68-77, 1963;.
20 +
Siren HJ, Litzow TJ:  Removal of certain hypophyseal tumors by the transantral-sphenoidal route . J Neurosurg 23:606-611, 1965;.
21 +
Rohde W, Knappe G, Mennig H, et al:  Assessment of somatotrophic hypophyseal function in acromegalic patients by estimation of serum growth hormone before and after surgical treatment . Hormone Res 4:129-140, 1973;.
22 +
Hardy J:  Transsphenoidal surgery of hypersecreting pituitary tumors , in Kohler PO, Ross GT (eds): The Diagnosis and Treatment of Pituitary Tumors . Amsterdam, Excerpta Medica, 1973;, pp 179-194.
23 +
Samaan NA, Leavens ME, Jesse RH Jr:  Serum growth hormone and prolactin response to thyrotropin-releasing hormone in patients with acromegaly before and after surgery . J Clin Endocrinol 38:957-963, 1974;.
24 +
Cryer PE, Daughaday WH:  Regulation of growth hormone secretion in acromegaly . J Clin Endocrinol 29:386-393, 1969;.
25 +
Glick SM, Roth J, Yalow RS, et al:  Immunoassay of human growth hormone in plasma . Nature 199:784-787, 1963;.
26 +
Catt K, Tregfar GW:  Solid-phase radioimmunoassay in antibody-coated tubes . Science 158:1570-1572, 1967;.
27 +
Earll JM, Sparks LL, Forsham PH:  Glucose suppression of serum growth hormone in the diagnosis of acromegaly . JAMA 201:628-630, 1967;.
28 +
Murphy BEP, Pattee CJ:  Determination of thyroxine utilizing the property of protein binding . J Clin Endocrinol 24:187-196, 1964;.
29 +
Noel GL, Dimond RC, Wartofsky L, et al:  Studies of prolactin and TSH secretion by continuous infusion of small amounts of thyrotropin-releasing-hormone (TRH) . J Clin Endocrinol 39:6-17, 1974;.
30 +
Porter CC, Silber RH:  A quantitative color reaction for cortisone and related 17, 21 dihydroxy-20 ketosteroids . J Biol Chem 185:201-207, 1950;.
31 +
Liddle GW, Estep HL, Kendall JW, et al:  Clinical application of a new test of pituitary reserve . J Clin Endocrinol 19:875-894, 1959;.
32 +
Gorden P, Roth J:  The treatment of acromegaly by conventional pituitary irradiation , in Proceedings of a Conference on Diagnosis and Treatment of Pituitary Tumors, Bethesda, Md, Jan 15-17, 1973 . International Congress series 303, Amsterdam, Excerpta Medica, 1974;, pp 230-233.
33 +
Levin SR, Hofeldt FD, Schneider V, et al:  Cryohypophysectomy for acromegaly: Factors associated with altered endocrine function and carbohydrate metabolism . Am J Med 57:526-535, 1974;.
34 +
Pearson OH:  Acromegaly , in Conn HF (ed): Current Therapy. Philadelphia, WB Saunders Co, 1974;, pp 464-466.
35 +
Williams RA, Jacobs HS, Kurtz AB, et al:  The treatment of acromegaly with special reference to trans-sphenoidal hypophysectomy . Quart J Med 44:79-98, 1975;.

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