Ergebnisse der Zweitoperation bei Patienten mit wachstumshormonsekretierendem Hypophysenadenom bei persistierender oder rezidivierender Akromegalie: Eine retrospektive Monozenter-Analyse.

Acromegaly results from excessive growth hormone (GH) secretion by pituitary adenomas, leading to persistently elevated GH levels, increased morbidity, and reduced life expectancy. The primary goals of treatment are lowering GH and IGF-1 levels, controlling tumor size, reducing morbidity and mortality, and improving quality of life. Surgery provides the advantage of immediate GH reduction compared to other therapies. This retrospective analysis evaluated clinical outcomes, therapeutic goals, and factors influencing the success of second surgery for persistent or recurrent acromegaly in 95 patients.

Between 1999 and 2017, 95 patients (38 women, 57 men; mean age 38 years) underwent second surgery for persistent or recurrent acromegaly (94 transsphenoidal, 1 transcranial). Follow-up was conducted 12 weeks postoperatively. Parasellar tumor extension was graded using the Knosp classification to ensure consistent radiological evaluation.

Surgical outcomes were assessed based on the latest stringent criteria for cure. We analyzed whether surgical goals were achieved and examined influencing factors, including tumor invasiveness, preoperative GH/IGF-1 levels, tumor histology, preoperative medical treatment, and the interval between surgeries. Additionally, we reviewed the rates of transient and persistent complications after the second procedure.

Surgical goals were achieved in 87.1% of cases. Remission rates were significantly correlated with Knosp grade, the extent of tumor mass reduction, and the relationship between preoperative GH levels and early postoperative outcomes. Intraoperative complications, such as bleeding, were minimal and did not require secondary surgical intervention.

Second surgery is an effective treatment option for patients with persistent or recurrent acromegaly, offering the potential for remission or cure. Success is influenced by factors such as preoperative GH/IGF-1 levels, tumor size, invasiveness, and surgical expertise.