Reply to “Predictors of surgical outcome and early criteria of remission in acromegaly—some controversial issues”

摘要

First, the authors questioned that we defined surgical remission with the GH and IGF-I levels 3 months after surgery. They cited their own unpublished data to question this time period of evaluation and also the last Endocrine Society guideline [3]. We agree that in some cases, normalization of IGF-I can take more than 12 weeks, but in these cases there is generally a great decrease of IGF-I levels after 12 weeks and, also, GH levels are below 1.0?μg/L. From the 38 patients not cured by surgery, only three patients presented GH levels below 1.0?μg/L 3 months after surgery. In these three patients, medical therapy with octreotide was started and despite 1 year of treatment with the maximum dose, they still presented elevated IGF-I levels, therefore, we can assure that they were not cured by surgery