Wide variation in surgical outcomes for acromegaly in the UK

P. R. Bates, M. N. Carson, P. J. Trainer, J. A H Wass, J. S. Bevan, A. B. Atkinson, S. R. Peacey, P. M. Stewart, M. C. Sheppard, C. M. Dayan, K. Chatterjee, M. F. Scanlon, G. P. Leese, B. R. Walker, A. W. Patrick, B. Vaidya, J. M C Connell, B. Allan, Stephen Atkin, S. Orme & 64 others T. A. Howlett, J. P. Vora, P. J. Jenkins, S. Aylwin, P. Bouloux, J. R E Davis, P. J. Trainer, S. Shalet, R. A. James, J. A H Wass, S. J. Howell, P. A. Vice, J. Newell-Price, R. J M Ross, R. N. Clayton, P. Jennings, A. Booth, N. Brown, A. Alexander, N. Holden, L. Jablonski, D. Wright, M. Hunt, J. Taheri, C. Holmes, E. Woods, T. Brown, S. Roberts, M. Carson, L. Goss, S. Revesz, K. Campbell, D. Grant, C. Smith, S. Cleary, C. Spink, T. Howlett, M. Chapman, P. Corlett, B. Morton, P. Whittingham, L. Conrich, C. Gaygon, S. Owusu-Antwi, E. Stobie, E. Walker-Scott, J. Gilbert, C. Gaygon, T. Drowley, C. Gibson, M. Roberts, J. Gebbie, P. Henderson, K. Johnstone, A. Murphy, C. Cowshill, V. Fazal-Sanderson, R. Smith, S. Parkington, A. Doane, V. Ibbotson, R. Lynch, M. Brown, E. Barry

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Objective: Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series. Design: Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services. Patients: Cases of acromegaly, presenting in 1970-2004, with levels of GH or IGF-1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH-lowering pharmacological therapy was permitted only if suspended for biochemical testing. Measurements: Percentage of cases with 'safe' mean postoperative GH levels (< 5 mU/l) and/or IGF-1 in the age- and sex-adjusted normal range. Results: 'Safe' GH, normal IGF-1, or both was achieved for 26%, 29% and 20% of extrasellar macroadenomas (> 1 cm), respectively, 39%, 39% and 29% of intrasellar macroadenomas, 56%, 51% and 37% of microadenomas (< 1 cm) and 39%, 39% and 28% of cases overall. In centres contributing more than 10 patients' data, rates of safe GH levels ranged from 20% to 68% and IGF-1 from 19% to 55%. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter. Conclusions: Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60%. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF-1 levels for the majority of cases.

Original languageEnglish
Pages (from-to)136-142
Number of pages7
JournalClinical Endocrinology
Volume68
Issue number1
DOIs
Publication statusPublished - Jan 2008
Externally publishedYes

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Acromegaly
Insulin-Like Growth Factor I
National Health Programs
Observational Studies
Radiotherapy
Prospective Studies
Pharmacology

ASJC Scopus subject areas

  • Endocrinology

Cite this

Bates, P. R., Carson, M. N., Trainer, P. J., Wass, J. A. H., Bevan, J. S., Atkinson, A. B., ... Barry, E. (2008). Wide variation in surgical outcomes for acromegaly in the UK. Clinical Endocrinology, 68(1), 136-142. https://doi.org/10.1111/j.1365-2265.2007.03012.x

Wide variation in surgical outcomes for acromegaly in the UK. / Bates, P. R.; Carson, M. N.; Trainer, P. J.; Wass, J. A H; Bevan, J. S.; Atkinson, A. B.; Peacey, S. R.; Stewart, P. M.; Sheppard, M. C.; Dayan, C. M.; Chatterjee, K.; Scanlon, M. F.; Leese, G. P.; Walker, B. R.; Patrick, A. W.; Vaidya, B.; Connell, J. M C; Allan, B.; Atkin, Stephen; Orme, S.; Howlett, T. A.; Vora, J. P.; Jenkins, P. J.; Aylwin, S.; Bouloux, P.; Davis, J. R E; Trainer, P. J.; Shalet, S.; James, R. A.; Wass, J. A H; Howell, S. J.; Vice, P. A.; Newell-Price, J.; Ross, R. J M; Clayton, R. N.; Jennings, P.; Booth, A.; Brown, N.; Alexander, A.; Holden, N.; Jablonski, L.; Wright, D.; Hunt, M.; Taheri, J.; Holmes, C.; Woods, E.; Brown, T.; Roberts, S.; Carson, M.; Goss, L.; Revesz, S.; Campbell, K.; Grant, D.; Smith, C.; Cleary, S.; Spink, C.; Howlett, T.; Chapman, M.; Corlett, P.; Morton, B.; Whittingham, P.; Conrich, L.; Gaygon, C.; Owusu-Antwi, S.; Stobie, E.; Walker-Scott, E.; Gilbert, J.; Gaygon, C.; Drowley, T.; Gibson, C.; Roberts, M.; Gebbie, J.; Henderson, P.; Johnstone, K.; Murphy, A.; Cowshill, C.; Fazal-Sanderson, V.; Smith, R.; Parkington, S.; Doane, A.; Ibbotson, V.; Lynch, R.; Brown, M.; Barry, E.

In: Clinical Endocrinology, Vol. 68, No. 1, 01.2008, p. 136-142.

Research output: Contribution to journalArticle

Bates, PR, Carson, MN, Trainer, PJ, Wass, JAH, Bevan, JS, Atkinson, AB, Peacey, SR, Stewart, PM, Sheppard, MC, Dayan, CM, Chatterjee, K, Scanlon, MF, Leese, GP, Walker, BR, Patrick, AW, Vaidya, B, Connell, JMC, Allan, B, Atkin, S, Orme, S, Howlett, TA, Vora, JP, Jenkins, PJ, Aylwin, S, Bouloux, P, Davis, JRE, Trainer, PJ, Shalet, S, James, RA, Wass, JAH, Howell, SJ, Vice, PA, Newell-Price, J, Ross, RJM, Clayton, RN, Jennings, P, Booth, A, Brown, N, Alexander, A, Holden, N, Jablonski, L, Wright, D, Hunt, M, Taheri, J, Holmes, C, Woods, E, Brown, T, Roberts, S, Carson, M, Goss, L, Revesz, S, Campbell, K, Grant, D, Smith, C, Cleary, S, Spink, C, Howlett, T, Chapman, M, Corlett, P, Morton, B, Whittingham, P, Conrich, L, Gaygon, C, Owusu-Antwi, S, Stobie, E, Walker-Scott, E, Gilbert, J, Gaygon, C, Drowley, T, Gibson, C, Roberts, M, Gebbie, J, Henderson, P, Johnstone, K, Murphy, A, Cowshill, C, Fazal-Sanderson, V, Smith, R, Parkington, S, Doane, A, Ibbotson, V, Lynch, R, Brown, M & Barry, E 2008, 'Wide variation in surgical outcomes for acromegaly in the UK', Clinical Endocrinology, vol. 68, no. 1, pp. 136-142. https://doi.org/10.1111/j.1365-2265.2007.03012.x
Bates PR, Carson MN, Trainer PJ, Wass JAH, Bevan JS, Atkinson AB et al. Wide variation in surgical outcomes for acromegaly in the UK. Clinical Endocrinology. 2008 Jan;68(1):136-142. https://doi.org/10.1111/j.1365-2265.2007.03012.x
Bates, P. R. ; Carson, M. N. ; Trainer, P. J. ; Wass, J. A H ; Bevan, J. S. ; Atkinson, A. B. ; Peacey, S. R. ; Stewart, P. M. ; Sheppard, M. C. ; Dayan, C. M. ; Chatterjee, K. ; Scanlon, M. F. ; Leese, G. P. ; Walker, B. R. ; Patrick, A. W. ; Vaidya, B. ; Connell, J. M C ; Allan, B. ; Atkin, Stephen ; Orme, S. ; Howlett, T. A. ; Vora, J. P. ; Jenkins, P. J. ; Aylwin, S. ; Bouloux, P. ; Davis, J. R E ; Trainer, P. J. ; Shalet, S. ; James, R. A. ; Wass, J. A H ; Howell, S. J. ; Vice, P. A. ; Newell-Price, J. ; Ross, R. J M ; Clayton, R. N. ; Jennings, P. ; Booth, A. ; Brown, N. ; Alexander, A. ; Holden, N. ; Jablonski, L. ; Wright, D. ; Hunt, M. ; Taheri, J. ; Holmes, C. ; Woods, E. ; Brown, T. ; Roberts, S. ; Carson, M. ; Goss, L. ; Revesz, S. ; Campbell, K. ; Grant, D. ; Smith, C. ; Cleary, S. ; Spink, C. ; Howlett, T. ; Chapman, M. ; Corlett, P. ; Morton, B. ; Whittingham, P. ; Conrich, L. ; Gaygon, C. ; Owusu-Antwi, S. ; Stobie, E. ; Walker-Scott, E. ; Gilbert, J. ; Gaygon, C. ; Drowley, T. ; Gibson, C. ; Roberts, M. ; Gebbie, J. ; Henderson, P. ; Johnstone, K. ; Murphy, A. ; Cowshill, C. ; Fazal-Sanderson, V. ; Smith, R. ; Parkington, S. ; Doane, A. ; Ibbotson, V. ; Lynch, R. ; Brown, M. ; Barry, E. / Wide variation in surgical outcomes for acromegaly in the UK. In: Clinical Endocrinology. 2008 ; Vol. 68, No. 1. pp. 136-142.
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title = "Wide variation in surgical outcomes for acromegaly in the UK",
abstract = "Objective: Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series. Design: Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services. Patients: Cases of acromegaly, presenting in 1970-2004, with levels of GH or IGF-1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH-lowering pharmacological therapy was permitted only if suspended for biochemical testing. Measurements: Percentage of cases with 'safe' mean postoperative GH levels (< 5 mU/l) and/or IGF-1 in the age- and sex-adjusted normal range. Results: 'Safe' GH, normal IGF-1, or both was achieved for 26{\%}, 29{\%} and 20{\%} of extrasellar macroadenomas (> 1 cm), respectively, 39{\%}, 39{\%} and 29{\%} of intrasellar macroadenomas, 56{\%}, 51{\%} and 37{\%} of microadenomas (< 1 cm) and 39{\%}, 39{\%} and 28{\%} of cases overall. In centres contributing more than 10 patients' data, rates of safe GH levels ranged from 20{\%} to 68{\%} and IGF-1 from 19{\%} to 55{\%}. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter. Conclusions: Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60{\%}. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF-1 levels for the majority of cases.",
author = "Bates, {P. R.} and Carson, {M. N.} and Trainer, {P. J.} and Wass, {J. A H} and Bevan, {J. S.} and Atkinson, {A. B.} and Peacey, {S. R.} and Stewart, {P. M.} and Sheppard, {M. C.} and Dayan, {C. M.} and K. Chatterjee and Scanlon, {M. F.} and Leese, {G. P.} and Walker, {B. R.} and Patrick, {A. W.} and B. Vaidya and Connell, {J. M C} and B. Allan and Stephen Atkin and S. Orme and Howlett, {T. A.} and Vora, {J. P.} and Jenkins, {P. J.} and S. Aylwin and P. Bouloux and Davis, {J. R E} and Trainer, {P. J.} and S. Shalet and James, {R. A.} and Wass, {J. A H} and Howell, {S. J.} and Vice, {P. A.} and J. Newell-Price and Ross, {R. J M} and Clayton, {R. N.} and P. Jennings and A. Booth and N. Brown and A. Alexander and N. Holden and L. Jablonski and D. Wright and M. Hunt and J. Taheri and C. Holmes and E. Woods and T. Brown and S. Roberts and M. Carson and L. Goss and S. Revesz and K. Campbell and D. Grant and C. Smith and S. Cleary and C. Spink and T. Howlett and M. Chapman and P. Corlett and B. Morton and P. Whittingham and L. Conrich and C. Gaygon and S. Owusu-Antwi and E. Stobie and E. Walker-Scott and J. Gilbert and C. Gaygon and T. Drowley and C. Gibson and M. Roberts and J. Gebbie and P. Henderson and K. Johnstone and A. Murphy and C. Cowshill and V. Fazal-Sanderson and R. Smith and S. Parkington and A. Doane and V. Ibbotson and R. Lynch and M. Brown and E. Barry",
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TY - JOUR

T1 - Wide variation in surgical outcomes for acromegaly in the UK

AU - Bates, P. R.

AU - Carson, M. N.

AU - Trainer, P. J.

AU - Wass, J. A H

AU - Bevan, J. S.

AU - Atkinson, A. B.

AU - Peacey, S. R.

AU - Stewart, P. M.

AU - Sheppard, M. C.

AU - Dayan, C. M.

AU - Chatterjee, K.

AU - Scanlon, M. F.

AU - Leese, G. P.

AU - Walker, B. R.

AU - Patrick, A. W.

AU - Vaidya, B.

AU - Connell, J. M C

AU - Allan, B.

AU - Atkin, Stephen

AU - Orme, S.

AU - Howlett, T. A.

AU - Vora, J. P.

AU - Jenkins, P. J.

AU - Aylwin, S.

AU - Bouloux, P.

AU - Davis, J. R E

AU - Trainer, P. J.

AU - Shalet, S.

AU - James, R. A.

AU - Wass, J. A H

AU - Howell, S. J.

AU - Vice, P. A.

AU - Newell-Price, J.

AU - Ross, R. J M

AU - Clayton, R. N.

AU - Jennings, P.

AU - Booth, A.

AU - Brown, N.

AU - Alexander, A.

AU - Holden, N.

AU - Jablonski, L.

AU - Wright, D.

AU - Hunt, M.

AU - Taheri, J.

AU - Holmes, C.

AU - Woods, E.

AU - Brown, T.

AU - Roberts, S.

AU - Carson, M.

AU - Goss, L.

AU - Revesz, S.

AU - Campbell, K.

AU - Grant, D.

AU - Smith, C.

AU - Cleary, S.

AU - Spink, C.

AU - Howlett, T.

AU - Chapman, M.

AU - Corlett, P.

AU - Morton, B.

AU - Whittingham, P.

AU - Conrich, L.

AU - Gaygon, C.

AU - Owusu-Antwi, S.

AU - Stobie, E.

AU - Walker-Scott, E.

AU - Gilbert, J.

AU - Gaygon, C.

AU - Drowley, T.

AU - Gibson, C.

AU - Roberts, M.

AU - Gebbie, J.

AU - Henderson, P.

AU - Johnstone, K.

AU - Murphy, A.

AU - Cowshill, C.

AU - Fazal-Sanderson, V.

AU - Smith, R.

AU - Parkington, S.

AU - Doane, A.

AU - Ibbotson, V.

AU - Lynch, R.

AU - Brown, M.

AU - Barry, E.

PY - 2008/1

Y1 - 2008/1

N2 - Objective: Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series. Design: Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services. Patients: Cases of acromegaly, presenting in 1970-2004, with levels of GH or IGF-1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH-lowering pharmacological therapy was permitted only if suspended for biochemical testing. Measurements: Percentage of cases with 'safe' mean postoperative GH levels (< 5 mU/l) and/or IGF-1 in the age- and sex-adjusted normal range. Results: 'Safe' GH, normal IGF-1, or both was achieved for 26%, 29% and 20% of extrasellar macroadenomas (> 1 cm), respectively, 39%, 39% and 29% of intrasellar macroadenomas, 56%, 51% and 37% of microadenomas (< 1 cm) and 39%, 39% and 28% of cases overall. In centres contributing more than 10 patients' data, rates of safe GH levels ranged from 20% to 68% and IGF-1 from 19% to 55%. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter. Conclusions: Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60%. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF-1 levels for the majority of cases.

AB - Objective: Unsuccessful surgery for acromegaly has major consequences for the patient as well as financial consequences for the National Health Service (NHS). Surgical expertise affects the outcome. We have used the UK National Acromegaly Register to assess surgical outcomes in different centres to investigate whether these match the previously published case series. Design: Retrospective and prospective observational study by analysis of anonymized national computer register records derived from individual clinical case records from 22 UK endocrine units and their associated pituitary surgical services. Patients: Cases of acromegaly, presenting in 1970-2004, with levels of GH or IGF-1 (785 and 430 cases, respectively) recorded prior to transsphenoidal adenomectomy and in the 12 months postsurgery, before any subsequent pituitary surgery or radiotherapy. GH-lowering pharmacological therapy was permitted only if suspended for biochemical testing. Measurements: Percentage of cases with 'safe' mean postoperative GH levels (< 5 mU/l) and/or IGF-1 in the age- and sex-adjusted normal range. Results: 'Safe' GH, normal IGF-1, or both was achieved for 26%, 29% and 20% of extrasellar macroadenomas (> 1 cm), respectively, 39%, 39% and 29% of intrasellar macroadenomas, 56%, 51% and 37% of microadenomas (< 1 cm) and 39%, 39% and 28% of cases overall. In centres contributing more than 10 patients' data, rates of safe GH levels ranged from 20% to 68% and IGF-1 from 19% to 55%. Success rates in attaining safe postsurgical levels of GH improved only slightly in the UK between 1974 and 1999 but markedly thereafter. Conclusions: Surgical outcomes for acromegaly in UK centres vary widely and historically have not, except in a few centres, matched those of large published series, which mostly have a success rate around 60%. Results have, however, improved substantially since 2000 and in the most successful units match those of the best published series. Experience is an important determinant of surgical success in acromegaly and the very recent improvement in surgical results in the UK coincides with a trend to concentrate pituitary surgery in the hands of a smaller number of specialists. Therefore, patients should be offered surgery by a dedicated pituitary surgeon with a caseload sufficient to offer the prospect of safe postsurgical GH and IGF-1 levels for the majority of cases.

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U2 - 10.1111/j.1365-2265.2007.03012.x

DO - 10.1111/j.1365-2265.2007.03012.x

M3 - Article

VL - 68

SP - 136

EP - 142

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 1

ER -