Oral Presentation Australian and New Zealand Pituitary Alliance 2025

Objective assessment of headache burden and quality of life following endoscopic resection of growth hormone secreting pituitary adenoma in acromegaly (123901)

Si Woo SY Yoon 1 , Anne AJ Jian 1 , Yi Yuen YW Wang 2 , Tony TG Goldschlager 3 , Mendel MC Castle-Kirszbaum 3 , Jeremy JK Kam 3 , Yi Chen YZ Zhao 4 , James JK King 1 5
  1. Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
  2. Keyhole Neurosurgery, Melbourne, VIC, Australia
  3. Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
  4. Department of Ear, Nose and Throat, Royal Melbourne Hospital, Melbourne, VIC, Australia
  5. Department of Surgery, University of Melbourne, Melbourne, VIC, Australia

BACKGROUND Growth hormone (GH)-secreting pituitary adenomas are the commonest cause of acromegaly, with headache being a prevalent symptom that may significantly impair quality of life (QoL). This study aimed to evaluate changes in headache burden and QoL following endoscopic resection of GH-secreting pituitary adenomas in patients with acromegaly, using validated assessment tools.

METHODS In this cohort study, we looked at prospectively collected data of patients with acromegaly who underwent endoscopic trans-sphenoidal surgery between 2016 and 2025. Headache burden and QoL were assessed using the Headache Impact Test (HIT-6) and the Anterior Skull Base Questionnaire (ASBQ-35) pre-operatively, and at 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively.

RESULTS Of 86 acromegaly patients identified, 31 had both pre-operative and at least one post-operative HIT-6 scores. Baseline headache was present in 39% (HIT-6 >36). Overall, there was no statistically significant change in HIT-6 score when compared pre- and postoperatively at all time points. In the subgroup with pre-operative headache, HIT-6 score reduced by 6 (95% CI -11.2, -1.6, p=0.01) and 8 points (95% CI -14.1, -2.7, p=0.01) at 3 weeks and 6 months respectively, showing statistical significance. Overall QoL (ABSQ-35) declined at 3 weeks by 9 points but returned to baseline by 6 weeks and improved significantly at 6 and 12 months; 9 (95% CI 1.7, 17.2, p=0.02) and 14 points (95% CI 5.6, 22.1, p<0.05), respectively. In patients with pre-operative headache, QoL improvement was noted from 6 weeks onwards with statistical significance.

CONCLUSION Endoscopic resection may provide headache relief in acromegaly patients with pre-operative headache. Transient early declines in QoL were observed postoperatively, which resolved by 6 weeks, and significant improvements were seen thereafter irrespective of pre-operative headache status. These findings support the role of surgery in improving symptom burden and QoL, particularly in patients presenting with headache.