Is Knosp enough? A novel classification for Acromegaly: a retrospective analysis of cure rates and outcome predictors in a large tertiary centre
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Authors
Fayez, Feras
Abougamil, Ahmed
Vitulli, Francesca
Knight, James
Syrris, Christoforos
Genel, Oktay
Shapey, Jonathan
Maratos, Eleni
Thomas, Nicholas
Barazi, Sinan
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Issue Date
2025
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Article
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PURPOSE: This 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. METHODS: This 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. RESULTS: Out 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. CONCLUSIONS: This 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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Acta Neurochirurgica
Volume
167
Issue
1