The dissertation is devoted to the actual problem of neurosurgery — improve the results of treatment of patients with pituitary adenomas secreting somatotropic hormone, on the basis of evaluation of clinical, laboratory, structural changes under the influence of complex treatment and to develop schemes of stages of diagnostic and treatment measures.
Instrumental research methods included skull radiography, MRI diagnostics. MRI diagnosis was performed on 150 (100%) patients. In 50% of the cases, the study was conducted using paramagnetic contrast media. These MRI studies allowed to determine the localization of hypertension. MRI head also made it possible to diagnose the spread of the tumor in the cavernous / sinus.
All patients (100%, 150 people) have undergone surgical intervention. Of all patients included in the study, 118 (78,7%) patients were operated initially, 32 (21,3%) — again due to prolonged hypertension. Most of the surgical operations were implemented within 5–10 years of the onset of the disease (61,3%).
The nearest results of surgical treatment of pituitary adenomas with acromegaly syndrome were evaluated 3–5 days after surgery and at the time of discharge from the hospital.
Normalization of GH was noted in 82 (72,6%) patients with 113 with an elevated level of this hormone.
The results of treatment in the long term were evaluated 6, 12 months after the primary surgical treatment in 135 (90%) patients, 24 and 36 months in 107 (71,3%) patients and over 36 months — 65 (43,3%) patients .
Complete clinical and laboratory remission was achieved in 102 (75,6%) cases with GH below 20 mIU/L. In 11 (8,1%) patients, hypopituitary syndrome persisted, requiring ongoing replacement therapy. 8 (5,9%) patients were disabled due to persistent hormonal disorders, 3 (2,2%) patients were disabled due to persistent visual impairments.
To analyze the relationship between the initial growth hormone level and the need for adjuvant therapy in the postoperative period, an ROC analysis was used to construct the ROC curve. The GH level for this clinical outcome was 58,9 mIU/L, specificity (Sp) 53,8%, sensitivity (S) 77,1%, p≤0,05. It was found that out of 45 patients with baseline GH less than 58,9 mIU/L adjuvant therapy was prescribed in 15 (33,3%) cases. At baseline levels of GH above 58.9 mIU/L, an additional treatment option was needed in 52 (76,5%) of 68 patients (χ2 Pyrson – 20,88, p<0,01).
For adjuvant therapy, somatostanin analogues were given to 13 (8,7%) patients. At the stage of assessing the sensitivity and individual tolerability of the drug in the 1 st patient, allergic reactions appeared in the form of skin congestion, urticaria rash, local itching in the injection site and shortness of breath. Further therapy with this drug is discontinued.
In the analysis of long-term results, the effectiveness of surgical treatment combined with the administration of Sandostatin LAR makes up 84,6% (11 out of 13 patients) with a stable clinical and laboratory remission.
Dopamine receptor agonists were prescribed immediately after surgical treatment: bromocriptine — 22 patients and cabergolin — 19 patients, of which steady clinical and laboratory remission was observed in 5 (22,7%) and 8 (42,1%) cases, respectively.
After 3, 6, 9 and 12 months after stereotactic radiosurgery and stereotactic radiotherapy, control MRI with intravenous contrast agent was administered. Signs of positive dynamics were considered: reduction of the size of the center (at least one of the maximum sizes), more heterogeneous MR-characteristics in T2 and T1 weighted images (VI), less intensive and heterogeneous accumulation of the focal contrast agent, decrease the compression and deformation of adjacent structures of the brain . All 9 patients were able to evaluate the dynamics of the process by the results of MRI of the brain after 6, 12, 24, 36 months after stereotactic treatment. Progression of tumor growth was defined as an increase of at least 15% tumor volume compared with the initial one. Tumor regression was defined as a decrease in tumor volume by at least 15% compared with baseline (partial tumor response). The volume of the tumor ± 15% of the original was defined as stable (stable). The partial response of the tumor was noted in 7 (77,8%) patients, stabilization — in 2 (22,2%), the progression of tumor growth was not observed.
Thus, the tactics of treating somatotropin producing adipose of the pituitary gland are milestone and require a multidisciplinary approach involving the endocrinologist, ophthalmologist, neurosurgeon. The best remote results were observed in patients undergoing surgical treatment followed by adjuvant or radiotherapy depending on the level of STH, the magnetic resonance imaging, and the degree of tumor proliferation according to the KI-67 criterion.
