ArticleActa neurochirurgica2025
Is Knosp enough? A novel classification for Acromegaly: a retrospective analysis of cure rates and outcome predictors in a large tertiary centre.
Article in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
purposeThis study evaluates surgical outcomes for acromegaly at King's College Hospital(2012-2022), focusing on predictive factors for surgical cure. A novel radiological metric, the MI Ratio, is introduced to enhance the prediction of clinical remission post-surgery, providing a more accurate prognosis and informing treatment planning.
methodsThis single-centre cohort study involved a retrospective analysis of prospectively collected data from a UK tertiary referral centre. Included were patients with histologically proven somatotroph tumours who underwent endoscopic trans-sphenoidal surgery (TSS) between 2012 and 2022. Exclusions were made for incomplete data or lost follow-up. Patient demographics, tumour characteristics, radiological parameters, and biochemical markers were analysed. The MI Ratio was defined as the distance from the midline to the lateral maximum of a tumour, divided by the distance between the two cavernous carotid arteries on coronal MRI.
resultsOut of 157 patients, 150 met the inclusion criteria. Using the 2018 consensus OGTT nadir < 0.40 ng/mL, microadenomas had a higher surgical cure rate (72%) compared to macroadenomas (48%), with an overall cure rate of 53%. Significant predictors of surgical cure included the MI Ratio (p < 0.001), microadenomas (p = 0.022), Knosp score < 2 (p = 0.012), immediate post-operative GH level (p = 0.016), and patient gender (p = 0.005). Pre-operative medical management did not significantly impact surgical remission (p = 0.19), while pre-operative GH level approached significance (p = 0.06). CV between operators for MI was < 5% indicating minimal Interoperator variability.
conclusionsThis study is the first to describe the MI Ratio, demonstrating its utility in predicting surgical remission in acromegaly patients. A combination of radiological features, demographics, and hormone profiles can more accurately identify patients less likely to achieve surgical cure.
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