Clinical Study On Postoperative Follow-up And Preoperative Treatment Of Secondary Diabetes Mellitus In Patients With Growth Hormone-secreting Pituitary Adenoma

Objective: To provide some evidences for establishing individualized clinical treatment programs of patients with growth hormone (GH)-secreting pituitary adenoma, through accessing different curative effect of microsurgery, preoperative somatostatin analogue and postoperative adjuvant radiotherapy on GH-secreting pituitary adenoma. To explore the effect of lanreotide on secondary diabetes mellitus with growth hormone-secreting pituitary adenoma.Methods: The clinical data of 103 patients with GH-secreting pituitary adenoma which undergone microsurgery were analyzed retrospectively. The tumors were classified according to therapeutic methods, preoperative serum GH level , tumor size and invasiveness. According to the criterion of cure of GH-secreting adenoma, the postoperative serum GH level, serum IGF-Ιlevel (normal age- and sex-matched range of IGF-I) and the degree of GH depression after OGTT were used to evaluating the therapeutic effect. 22 secondary diabetic patients were respectively treated with lanreotide and insulin preoperatively. Based on fasting blood-glucose(FBG), to evaluate the effect of lanreotide on secondary diabetes mellitus.Results: 17 patients were not revisited because of some reasons. There were 33 invasive adenomas, 34 noninvasive macroadenomas and 19 microadenomas in all 86 patients. All patients were treated by transsphenoidal adenomectomy except 5 patients via pterional approach. The mean follow-up time was 32.4±12 months. The rate of overall remission was 57.0% and 4.7% recurrence rate in these patients. The remission rate after simple operation in patients with microadenoma, noninvasive macroadenoma and invasive adenoma was 83.3%, 50% and 28.6% respectively; the remission rate in patients used somatostatin analogue preoperatively with microadenoma, noninvasive macroadenoma and invasive adenoma was 85.7%, 75% and 42.9% respectively; the remission rate in patients of postoperative adjuvant radiotherapy with noninvasive macroadenoma and invasive adenoma was 64.2% and 41.7% respectively. The prognoses was related to the level of serum GH, the tumor size and invasiveness.Whether preoperative pharmacy or postoperative radiotherapy improved treatment results of invasive adenomas. The FBG levels of 22 secondary diabetic patients reduced from 14.7±3.5 mmol.L-1 to 8.6±2.7 mmol.L-1 in the lanreotide group but decreased from 16.8±4.7mmol.L-1 to 12.4±3.1mmol.L-1 in the insulin group. Lanreotide is superior to insulin in glycemic control rate(46.2% VS 33.3%, P<0.05).Conclusions:It is a effective method that patients with GH-secreting pituitary adenoma are treated by the means of transsphenoidal adenomectomy. There are good results in microadenomas and noninvasive macroadenomas (Knosp gradeⅠ~Ⅱ) after simple microsurgery, but its curative effect on the patients with invasive adenomas (Knosp gradeⅢ~Ⅳ) is unsatisfactory, so they should be treated by preoperative somatostatin analogue or adjuvant three-dimension conformal radiotherapy after surgery. Lanreotide can control FBG of secondary diabetic patients quickly which is better than other antidiabetic medicines.