Biochemical Remission Of Pituitary Growth Hormone Adenoma After Transsphenoidal Surgery Analysis Of Related Factors And Predictive Factor

Objective:Transsphenoidal surgery(TSS)is the preferred treatment for pituitary growth hormone adenomas,but without strong predictors of early surgical outcomes,biochemical remission can only be determined within three months or longer after surgery,resulting in delays in the treatment of some patients requiring follow-up treatment.The purpose of this study is to explore and analyze the related factors affecting the biochemical remission of pituitary growth hormone adenomas after transsphenoidal surgery and the early predictive factors that can be used for post-operative remission,so as to provide reference for patients who do not achieve biochemical remission after surgery as soon as possible and to start early follow-up treatment.Methods:The clinical data of 35 patients with pituitary growth hormone adenoma diagnosed by transsphenoidal surgery and pathological examination from January 2017 to December 2018 were retrospectively analyzed.The data collected included sex,age,size of tumors,preoperative GH level and GH level within 24 hours after operation,Knosp classification,Ki-67 index in immunohistochemistry,Selection of transsphenoidal surgery,etc.Biochemical remission criteria were defined as age-and gender-adjusted normal range of IGF-1 levels,random GH levels below 1?g/L at least three months after surgery,or the lowest serum GH levels below 0.4?g/L in oral glucose tolerance tests.Statistical methods were used to analyze the correlation between various factors in the collected data and post-operative remission,so as to understand the relevant factors of biochemical remission after surgery,and to further evaluate the existence of predictive factors for post-operative remission.Results:Thirty-five patients with pituitary growth hormone adenoma included 17 males(48.6%)and 18 females(51.4%)with an average age of 44.69±13.95 years.The size of the adenoma ranged from 0,98cm to 4.5cm.The preoperative GH averaged 16.09±20.91 ?g/L and the within 24-hour after operation GH averaged 6.56±15.99?g/L.Of the 35 patients,17 achieved biochemical remission after transsphenoidal surgery,18 did not,and the overall biochemical remission was 48.6%.Sex,age,size of tumors,Ki-67 index,Selection of transsphenoidal surgery and other factors have no significant relationship with the biochemical remission rate after operation,P>0.05.Through single factor analysis,three factors with statistical significance were screened out:GH level before operation,GH level within 24 hours after operation,Knosp classification.Further analysis by stepwise logistic regression analysis showed that GH levels within 24 hours after operation had significant influence on the remission rate(P<0.05),and GH levels within 24 hours after operation<1,1-2.5 were protective factors affecting the remission rate.Conclusion:1.GH level within 24 hours after operation is an independent factor affecting biochemical remission of pituitary growth hormone adenoma after transsphenoidal surgery(TSS).2.GH level<2.5 ?g/L within 24 hours after operation can be used as an early predictor of biochemical remission after operation.If GH level measured within 24 hours after operation is higher than this standard,clinically,it is not necessary to wait until 3 months after operation to evaluate the remission,then follow-up medication or other adjuvant treatment can be started after operation rehabilitation,so as to shorten the waiting time for treatment and biochemical remission.