Analysis On Treatment Effects Of Preoperative Long-acting Somatostatin Analogs And Trans-sphenoidal Endoscopic Surgery For Patients With Growth Hormone(GE)-secreting Pituitary Macroadenomas

Pituitary growth hormone adenomas are rarly in the clinical.Patients often have acromegaly performance with growth hormone and insulin-like growth factor 1(IGF-1)continued rising.Acromegaly often associated with a variety of endocrine and metabolic disorders symptoms,and because of the slow progresion,the diagnosis of the disease has entered the late period,and even part of the large adenomas have invaded cavernous sinus,Greatly increased the difficulty of surgery and postoperative recurrence rate.Surgical may be the first way for the treatment.Nowadays,neuroendoscopic transsphenoidal approach with its wide field of vision,high full resection rate,low trauma and short time to carry out was widly accepted.Almost 90% of GH adenoma Patients can apply this method,but surgery alone can not make all patients achieve complete biochemical remission.Domestic and foreign studies have shown that preoperative use of long-acting somatostatin analogues(Somatostatin Analogs,SSA)can inhibit the growth of some growth hormone adenomas,improve the rate of total resection and biochemical response rate,but the conclusion still need further clinical research.To evaluate the treatment effects of preoperative long-acting somatostatin analogue(SSA)and trans-sphenoidal endoscopic surgery for patients with growth hormone(GH)-secreting pituitary macroadenomas.Retrospective analysis was carried out from January 2010 to January 2016 on 20 patients with growth hormone(GH)-secreting pituitary macroadenomas who were treated with preoperative SSA and trans-sphenoidal endoscopic surgery in our apartment.We also select 20 patients with only trans-sphenoidal endoscopic surgery treatment and 20 patients with preoperative SSA and non-trans-sphenoidal endoscopic surgery treatment.The changes of tumor imaging,endocrine and blood pressure before and after treatment were analysed.There was no statistically significant difference in sex,age,duration and follow-up time between the three groups,but the invasion / noninvasive ratio of pituitary GH adenoma in SSA combined endoscopy group was higher than that in endoscopic group and SSA combined with nonoscopic Surgery group(15/5 vs 8/12 and 9/11).There are significant differences in Gross total resection(GTR)rate of invasive growth hormone(GH)-secreting pituitary macroadenomas between only trans-sphenoidal endoscopic surgery group(4/16)and preoperative SSA one(8/13)(P<0.05).Meanwhile,the latter group could significantly improve the GH levels,blood glucose,lipid metabolism and blood pressure levels(P <0.05).The trans-sphenoidal endoscopic surgery on patients with growth hormone(GH)-secreting pituitary macroadenomas has a significant improvement on GH levels,blood glucose,lipid metabolism and blood pressure levels.Through the treatment of preoperative long-acting somatostatin analogue(SSA),the gross total resection rate is higher than other two groups.But taking into account the cost of treatment,how long should we use long-acting somatostatin drugs is still under discussion.