| PurposeGrowth hormone-secreting pituitary adenomas accounting for 12.5%of pituitary adenomas,annual incidence rate(3?4)/1 million,often occurred after age 40,there is no significant difference between men and women.Adults with growth hormone adenomas predominantly develop acromegaly and can affect multiple systems and organs,skin,musculoskeletal system,cardiovascular system,endocrine and metabolic systems,digestive system,respiratory system,internal organs,neuro system.etc.Acromegaly is occult and the time from symptom onset to medical diagnosis is 5 to 10 years.Therefore,many patients seek medical treatment because of complications,among which hypertension,diabetes,and sleep apnea syndrome are the most common complications.Neuroendoscopic transsphenoidal pituitary tumor resection has become the mainstream treatment for pituitary adenomas,because of its precise therapeutic effect,less trauma,clearer vision,wider exposure range,precise surgical procedures,and faster postoperative recovery.However,in growth hormone adenomas,the total remission rate after surgery is approximately 68.3%.How to improve the prognosis of patients with pituitary adenomas is still the most concerned issue in neurosurgery.This study assessed the preoperative and postoperative hormone levels,which were reviewed to summarize the role of growth hormone in the surgical outcomes and prognostic evaluation of pituitary tumors and guide follow-up treatment.Materials and MethodThere are 75 patients collected with growth hormone adenoma who were admitted to Qilu Hospital of Shandong University from June 1st,2014 to June 1st,2017.Serum growth hormone was measured before operations,repeated 48 hours and 6 months after operation.,Prolactin,insulin growth factor-1 levels,we use statistical analysis system SPSS 21.0 studying the age,gender,invasion,tumor size,pathological type,etc.Tumor typeThese cases of growth hormone adenoma were hospitalized in our hospital,75 cases of GH adenomas were collected with complete data.All patients underwent surgical treatment and postoperative pathology confirmed GH adenomas,these patients were treated without other forms of treatment.We used telephone interviews to follow up.All statistical data were analyzed using SPSS 21.0 system.The sample rate was compared using the x2 test and the multivariate analysis was analyzed using a logistic regression model.P<0.05 was statistically significant.Results1.There are 33 males and 42 females in this article.The male to female is about 1:1.27.There was no significant difference between male and female within 48 hours after surgery(P=0.086>0.05);there was no significant difference between male and female after six months postoperatively(P=0.732>0.05).2.According to preoperative growth hormone levels,patients were divided into three groups(<20ug/L,20-50ug/L,?50ug/L),the total biological cure rate was 32.0%within 48 hours after surgery;<20ug/L group biological cure rate was 51.6%(16/31),the biological cure rate was 24.1%(7/29)in the 20-50ug/L group,and the biological cure rate was 6.7%(1/15)in the>50ug/L group.The difference in the cure rates of the three groups was statistically significant(P=0.005<0.05).In order to study the consistency of growth hormone within 48 hours after surgery and growth hormone after 6 months,Kappa=0.708 was calculated,which was between 0.60<k?0.80,indicating that the two methods have higher biological cure rates..3.For patients who did not reach the standard of cure after surgery,the growth rate of growth hormone in the 1-5ug/L group was 39.3%at 6 months postoperatively,with an average increase of 0.760ug/L.The rate of decline after 6 months was 70.7%,with an average decrease of 0.586ug/L.The growth rate of 5-10ug/L group was 0 and the decline rate of 100%after 6 months,an average decrease was 3.288ug/L.After 6 months,the growth rate of>10ug/L group was 27.3%,the average increase was 137.147ug/L,and the rate of decline was 72.7%after 6 months,with an average decrease of 11.620ug/L.There was a statistically significant difference in the rate of increase between the three groups after 6 months and 24 hours after operation(P<0.05).).By merging adjacent rows or adjacent columns,it was divided into 1?5ug/L group and>5ug/L group,and the difference between the two groups was statistically significant(P<0.05).4.We used the growth hormone level as the test variable after six months of surgery,and the postoperative growth hormone rate was the state variable,which resulted in AUC=0.785,suggesting that the postoperative growth hormone change rate can better reflect the postoperative growth hormone Level of the sixth-month(P<0.001).5.There was no statistical difference in the biological cure rate between the simple GH adenoma group and the mixed GH adenoma group within 48 hours after surgery.There was no significant difference in the cure rate between the simple GH adenoma group and the mixed GH adenoma group at the six months after operation.6.1n patients with invasive somatotropin adenomas,13.0%(3/23)of patients were cured who had received a review of growth hormone within 48 hours after surgery.In patients with non-invasive growth hormone,the recovery of growth hormone within 48 hours was 40.4%(21/52).The difference between the two groups was statistically significant(P=0.019<0.05).Of the patients with invasive somatotropin adenomas,17.4%(4/23)of those who reexamined growth hormone after six months postoperatively were treated.Six months postoperatively,In patients with non-invasive growth hormone the cure was 28.8%(15/52).There was no statistical difference between the two groups(P=0.293>0.05).Conclusion1.The prognosis of patients with growth hormone adenoma has no correlation between gender and age.2.Preoperative growth hormone levels are associated with the prognosis of patients with GH adenomas.The preoperative GH>20ug/L is worse than GH ? 20ug/L;the GH level can reflect the prognosis within 48 hours after surgery.Within 48 hours,GH<1ug/L can be considered as a complete surgical resection of the tumor,which can achieve long-term biological cure.3.Patients who do not meet the criteria for biologic recovery within 48 hours after surgery need long-term follow-up to regularly review MRI and hormone levels,Individualized choice of reoperation,drug therapy,radiation therapy.4.Randomized serum growth hormone<1ug/L at 48 hours after surgery was better than the rate of decline of growth hormone within 48 hours after surgery.However,growth hormone can be used when growth hormone does not reach the biological healing standard at 48 hours after operation.The rate of decline assesses the patient's prognosis.5.Tumor size was positively correlated with preoperative GH levels.6.There was no difference in the cure rate between patients with simple growth hormone adenoma and mixed growth hormone adenoma.7.The cure rate of non-invasive growth hormone adenomas was significantly higher than that of invasive adenomas within 48 hours after surgery,but there was no significant difference in the cure rate after 6 months.Non-invasive somatotroph adenomas can be removed,but postoperative hormone levels are easily rising and require long-term follow-up.8.Patients with mixed pituitary adenomas preferred surgical treatment.Oral dopamine agonists and somatostatin drugs also had significant effects. |
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