Postoperative complications in the surgical treatment of Acromegaly: a literature review of the last decade

Authors

DOI:

https://doi.org/10.33448/rsd-v10i14.21982

Keywords:

Acromegaly; Endocrinology; Revision.

Abstract

Introduction: Acromegaly is a syndrome manifested by hypersecretion of GH and IGF-1, which has consequences on cartilage closure, metabolic changes such as glucose intolerance and cardiovascular changes such as arterial hypertension. In most cases, this syndrome is linked to somatotropinomas in the Master Gland and is difficult to diagnose, as it has an insidious onset, usually noticed after 5 years of its onset. This condition affects the quality and average length of life of those who have it. Laboratory diagnosis can be done by measuring basal GH and IGF-1. As for the conduct, the first choice therapy is surgical, however, like any procedure, it presents complications. Thus, the objective is a better treatment and differentiated conduct, through the clarification of this situation regarding the postoperative period. Methodology: A literature review was carried out in the VHL, using the descriptors: “Acromegaly” AND “Postoperative Complications” from 2011 to 2021, with 16 selected articles. Results and discussion: Among the findings, it is observed that the endoscopic transsphenoidal approach is more advantageous in relation to the others. In addition, postoperative complications were classified into four categories: Complications related to the surgical procedure, such as infections and hemorrhages; ischemic complications; hormonal complications such as diabetes insipidus and GH tumor-related complications such as obstructive sleep apnea. Conclusion: Better management of patients with acromegaly after surgery is necessary, as this has the particularity related to sleep disorders, so that the conduct can be individualized and improved.

References

Adigun, O. O., Nguyen, M., Fox, T. J., & Anastasopoulou, C. (2021). Acromegaly. StatPearls [Internet].

Albarel, F., Castinetti, F., Morange, I., Conte‐Devolx, B., Gaudart, J., Dufour, H., & Brue, T. (2013). Outcome of multimodal therapy in operated acromegalic patients, a study in 115 patients. Clinical endocrinology, 78(2), 263-270.

Bhat, D. I., Jagatlal, G., & Devi, B. I. (2013). A rare vascular complication of transsphenoidal surgery. Acta neurochirurgica, 155(1), 131-134.

Botelho, L. L. R., de Almeida Cunha, C. C., & Macedo, M. (2011). O método da revisão integrativa nos estudos organizacionais. Gestão e sociedade, 5(11), 121-136.

Bruno, O. D. (2018). Acromegaly: a rare disease?. MEDICINA (Buenos Aires), 78(2), 83-85.

Chung, S. Y., Sylvester, M. J., Patel, V. R., Zaki, M., Baredes, S., Liu, J. K., & Eloy, J. A. (2018). Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: an analysis of inpatient data. The Laryngoscope, 128(5), 1027-1032.

Cossu, G., Al-Taha, K., Hajdu, S. D., Daniel, R. T., & Messerer, M. (2020). Carotid-cavernous fistula after transsphenoidal surgery: a rare but challenging complication. World neurosurgery, 134, 221-227.

Cote, D. J., Iuliano, S. L., Smith, T. R., & Laws Jr, E. R. (2015). Post-operative Streptococcus pneumoniae meningoencephalitis complicating surgery for acromegaly in an identical twin. Journal of Clinical Neuroscience, 22(6), 1041-1044.

da Cunha, M. L. V., Pletz, A. L. B., Borba, L. A. B., & Boguszewski, C. L. (2013). Postoperative structural complications after microscopic transsphenoidal surgery of GH secreting pituitary adenomas. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 32(04), 221-224.

Giustina, A., Barkan, A., Beckers, A., Biermasz, N., Biller, B. M., Boguszewski, C., ... & Melmed, S. (2020). A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. The Journal of Clinical Endocrinology & Metabolism, 105(4), e937-e946.

Guo, S., Wang, Z., Kang, X., Xin, W., & Li, X. (2021). A Meta-Analysis of Endoscopic vs. Microscopic Transsphenoidal Surgery for Non-functioning and Functioning Pituitary Adenomas: Comparisons of Efficacy and Safety. Frontiers in Neurology, 12, 352.

Gupta, R., Sharma, A., Vaishya, R., & Tandon, M. (2013). Ischemic complications after pituitary surgery: a report of two cases. Journal of Neurological Surgery Part A: Central European Neurosurgery, 74(S 01), e119-e123.

Kim, S. H., Kim, N., Min, K. T., Kim, E. H., Oh, H., & Choi, S. H. (2020). Sleep disturbance and delirium in patients with acromegaly in the early postoperative period after transsphenoidal pituitary surgery. Medicine, 99(45).

Kobayashi, N., Fukuhara, N., Fukui, T., Yamaguchi-Okada, M., Nishioka, H., & Yamada, S. (2014). Clinical characteristics of streptococcus pneumoniae meningoencephalitis after transsphenoidal surgery: three case reports. Neurologia medico-chirurgica, 54(8), 629-633.

Krzentowska-Korek, A., Gołkowski, F., Bałdys-Waligórska, A., & Hubalewska-Dydejczyk, A. (2011). Efficacy and complications of neurosurgical treatment of acromegaly. Pituitary, 14(2), 157-162.

Lampropoulos, K. I., Samonis, G., & Nomikos, P. (2013). Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: a study on 184 patients. Hormones, 12(2), 254-264.

Lavrentaki, A., Paluzzi, A., Wass, J. A., & Karavitaki, N. (2017). Epidemiology of acromegaly: review of population studies. Pituitary, 20(1), 4-9.

Leopoldo, C. M. D. S., Leopoldo, F. M. D. S., Santos, A. R. L. D., Veiga, J. C. E., Lima, J. V., Scalissi, N. M., ... & Dolci, R. L. L. (2017). Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery. Arquivos de neuro-psiquiatria, 75, 301-306.

Li, H. Y., Feng, C. Y., Zhang, C., Su, J., Yuan, J., Xie, Y., ... & Liu, Q. (2017). Microscopic surgery for pituitary adenomas to preserve the pituitary gland and stalk. Experimental and therapeutic medicine, 13(3), 1011-1016.

Phan, K., Xu, J., Reddy, R., Kalakoti, P., Nanda, A., & Fairhall, J. (2017). Endoscopic endonasal versus microsurgical transsphenoidal approach for growth hormone–secreting pituitary adenomas—systematic review and meta-analysis. World neurosurgery, 97, 398-406.

Prete, A., Corsello, S. M., & Salvatori, R. (2017). Current best practice in the management of patients after pituitary surgery. Therapeutic advances in endocrinology and metabolism, 8(3), 33-48.

Raikundalia, M. D., Pines, M. J., Svider, P. F., Baredes, S., Folbe, A. J., Liu, J. K., & Eloy, J. A. (2015, May). Characterization of transsphenoidal complications in patients with acromegaly: an analysis of inpatient data in the United States from 2002 to 2010. In International forum of allergy & rhinology (Vol. 5, No. 5, pp. 417-422).

Rieley, W., Askari, A., Akagami, R., Gooderham, P. A., Swart, P. A., & Flexman, A. M. (2020). Immediate use of continuous positive airway pressure in patients with obstructive sleep apnea following transsphenoidal pituitary surgery: a case series. Journal of neurosurgical anesthesiology, 32(1), 36-40.

Rotermund, R., Burkhardt, T., Rohani, Z., Jung, R., Aberle, J., & Flitsch, J. (2018). Value of early postoperative random growth hormone levels and nadir growth hormone levels after oral glucose tolerance testing in acromegaly. Growth Hormone & IGF Research, 41, 64-70.

Saldarriaga, C., Lyssikatos, C., Belyavskaya, E., Keil, M., Chittiboina, P., Sinaii, N., ... & Lodish, M. (2018). Postoperative diabetes insipidus and hyponatremia in children after transsphenoidal surgery for adrenocorticotropin hormone and growth hormone secreting adenomas. The Journal of pediatrics, 195, 169-174.

Starnoni, D., Daniel, R. T., Marino, L., Pitteloud, N., Levivier, M., & Messerer, M. (2016). Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis. Acta neurochirurgica, 158(11), 2109-2121.

Vilar, L., Vilar, C. F., Lyra, R., Lyra, R., & Naves, L. A. (2017). Acromegaly: clinical features at diagnosis. Pituitary, 20(1), 22-32.

Published

31/10/2021

How to Cite

BORGES, J. L. F. .; CARDOSO, A. L. C. .; CARDOSO, S. J. G. P. .; SASTRE, G. de S. .; OLIVEIRA, J. H. P. de .; GUIMARÃES, A. B. .; ANDRADE, M. C. S. .; PIRES, A. C. L. .; MORAES, E. S. de .; RODRIGUES, I. F. R. e .; SILVA, V. C. B. .; FRANCO, S. C. . Postoperative complications in the surgical treatment of Acromegaly: a literature review of the last decade. Research, Society and Development, [S. l.], v. 10, n. 14, p. e240101421982, 2021. DOI: 10.33448/rsd-v10i14.21982. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/21982. Acesso em: 4 dec. 2024.

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Section

Health Sciences