The impact of endoscopic transsphenoidal pituitary adenoma surgery on endocrine function: a single-centre study.
Adenoma
/ surgery
Adolescent
Adult
Aged
Aged, 80 and over
Diabetes Insipidus
/ complications
Female
Humans
Hypothalamo-Hypophyseal System
/ physiopathology
Male
Middle Aged
Neuroendoscopy
Pituitary Neoplasms
/ surgery
Pituitary-Adrenal System
/ physiopathology
Postoperative Complications
/ etiology
Postoperative Period
Quality of Life
Retrospective Studies
Treatment Outcome
Young Adult
Adenoma
Endocrine
Endoscopic
Outcome
Pituitary
Surgery
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
28
06
2020
accepted:
05
10
2020
pubmed:
23
10
2020
medline:
9
7
2021
entrez:
22
10
2020
Statut:
ppublish
Résumé
The outcome for pituitary endocrine function following endoscopic transsphenoidal surgery remains unclear. This study aims to evaluate endocrine outcomes following endoscopic surgery in order to provide a benchmark to assist in the counselling of patients perioperatively. A prospectively held pituitary database was retrospectively analysed for all adult pituitary adenoma patients undergoing endoscopic surgery from May 2011 to May 2017. All operations were performed by a single neurosurgeon at a regional centre for pituitary surgery. Functioning and non-functioning adenomas were included. Hormonal status was assessed at most recent follow-up. One hundred forty-five patients (69 M, 76 F) were included in the study with a median age of 52 years. Median follow-up was 52 months. Eighty-eight patients (61%) were not taking any hormone replacement medications, whilst 57 patients (39%) required hormone replacement therapy (HRT) preoperatively. Preoperatively, 29 patients (20%) had hypothalamo-pituitary-adrenal (HPA) axis dysfunction, 39 patients (27%) had thyroid axis dysfunction, 11 males (16%) and 7 females (9%) had gonadal axis dysfunction, and one patient had preoperative diabetes insipidus. Postoperatively, 26 patients (18%) had a new deficiency in pituitary function, whilst 6 patients (11%) were able to cease HRT. Nineteen patients (13%) had new HPA axis deterioration, 12 (8%) had new thyroid axis dysfunction, 8 males (11%) and 4 females (5%) had gonadal axis deterioration, and 6 patients (4%) had new diabetes insipidus (DI). The ability to restore pituitary function following endoscopic surgery remains limited, whilst new deficits still occur. It is essential that patients are counselled accordingly as hormonal replacement therapy can have a significant impact on quality of life. Larger longer-term collaborative studies of endocrine outcome in endoscopic pituitary surgery are needed.
Identifiants
pubmed: 33089449
doi: 10.1007/s00701-020-04609-x
pii: 10.1007/s00701-020-04609-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
391-398Références
Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, McCutcheon IE (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101(3):613–619
pubmed: 15274075
Theodros D, Patel M, Ruzevick J, Lim M, Bettegowda C (2015) Pituitary adenomas: historical perspective, surgical management and future directions. CNS Oncol 4(6):411–429
pubmed: 26497533
pmcid: 4750488
Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH (1994) Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 120(10):817–820
pubmed: 8154641
Lake MG, Krook LS, Cruz SV (2013) Pituitary adenomas: an overview. Am Fam Physician 88(5):319–327
pubmed: 24010395
Dattani M, Preece M (2004) Growth hormone deficiency and related disorders: insights into causation, diagnosis, and treatment. Lancet 363(9425):1977–1987
pubmed: 15194259
Ebrahimi F, Widmer A, Wagner U, Mueller B, Schuetz P, Christ-Crain M, Kutz A (2019) Association of adrenal insufficiency with patient-oriented health-care outcomes in adult medical inpatients. Eur J Endocrinol. https://doi.org/10.1530/EJE-19-0469
Higham CE, Johannsson G, Shalet SM (2016) Hypopituitarism. Lancet 388(10058):2403–2415
pubmed: 27041067
Arafah BM (1986) Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 62(6):1173–1179
pubmed: 3009521
Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR (1994) Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab 79(2):348–354
pubmed: 8045946
Berker M, Hazer DB, Yücel T, Gürlek A, Cila A, Aldur M, Onerci M (2012) Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary 15(3):288–300
pubmed: 22161543
Berkmann S, Fandino J, Müller B, Remonda L, Landolt H (2012) Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma. Acta Neurochir 154(4):639–647
pubmed: 22286656
Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97(2):293–298
pubmed: 12186456
Charalampaki P, Reisch R, Ayad A, Conrad J, Welschehold S, Perneczky A, Wüster C (2007) Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases. J Clin Neurosci 14(5):410–415
pubmed: 17386368
Colao A, Cerbone G, Cappabianca P, Ferone D, Alfieri A, Di Salle F, Faggiano A, Merola B, de Divitiis E, Lombardi G (1998) Effect of surgery and radiotherapy on visual and endocrine function in nonfunctioning pituitary adenomas. J Endocrinol Investig 21(5):284–290
Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J (1991) The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer 68(4):860–866
pubmed: 1855185
Dallapiazza RF, Grober Y, Starke RM, Laws ER, Jane JA (2015) Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas. Neurosurgery 76(1):42–52 discussion 52-53
pubmed: 25255271
Fatemi N, Dusick JR, Mattozo C, McArthur DL, Cohan P, Boscardin J, Wang C, Swerdloff RS, Kelly DF (2008) Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery 63(4):709–718 discussion 718-719
pubmed: 18981881
Gondim JA, Almeida JPC, Albuquerque LAF, Schops M, Gomes E, Ferraz T, Sobreira W, Kretzmann MT (2011) Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14(2):174–183
pubmed: 21181278
Harary M, DiRisio AC, Dawood HY, Kim J, Lamba N, Cho CH, Smith TR, Zaidi HA, Laws ER (2018) Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas. J Neurosurg:1–10
Jahangiri A, Wagner JR, Han SW et al (2016) Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis. J Neurosurg 124(3):589–595
pubmed: 26252454
Jahangiri A, Wagner J, Han SW, Tran MT, Miller LM, Tom MW, Ostling LR, Kunwar S, Blevins L, Aghi MK (2014) Rate and time course of improvement in endocrine function after more than 1000 pituitary operations. Neurosurgery 61(Suppl 1):163–166
pubmed: 25032545
Laws ER, Iuliano SL, Cote DJ, Woodmansee W, Hsu L, Cho CH (2016) A benchmark for preservation of normal pituitary function after endoscopic transsphenoidal surgery for pituitary macroadenomas. World Neurosurg 91:371–375
pubmed: 27113402
Nomikos P, Ladar C, Fahlbusch R, Buchfelder M (2004) Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas -- a study on 721 patients. Acta Neurochir 146(1):27–35
pubmed: 14740262
Webb SM, Rigla M, Wägner A, Oliver B, Bartumeus F (1999) Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab 84(10):3696–3700
pubmed: 10523016
Hayhurst C, Taylor PN, Lansdown AJ, Palaniappan N, Rees DA, Davies JS (2019) Current perspectives on recurrent pituitary adenoma: the role and timing of surgery vs adjuvant treatment. Clin Endocrinol. https://doi.org/10.1111/cen.14127
Bondugulapati LNR, Campbell C, Chowdhury SR, Goetz P, Davies JS, Rees DA, Hayhurst C (2016) Use of day 1 early morning cortisol to predict the need for glucocorticoid replacement after pituitary surgery. Br J Neurosurg 30(1):76–79
pubmed: 26313503
Wang EW, Zanation AM, Gardner PA et al (2019) ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 9(S3):S145–S365
pubmed: 31329374
Azad TD, Lee Y-J, Vail D, Veeravagu A, Hwang PH, Ratliff JK, Li G (2017) Endoscopic vs. microscopic resection of sellar lesions-a matched analysis of clinical and socioeconomic outcomes. Front Surg 4:33
pubmed: 28691009
pmcid: 5479879
Almutairi RD, Muskens IS, Cote DJ et al (2018) Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis. Acta Neurochir 160(5):1005–1021
pubmed: 29307020
Do H, Kshettry VR, Siu A, Belinsky I, Farrell CJ, Nyquist G, Rosen M, Evans JJ (2017) Extent of resection, visual, and endocrinologic outcomes for endoscopic endonasal surgery for recurrent pituitary adenomas. World Neurosurg 102:35–41
pubmed: 28286277
Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T (2017) Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary adenoma: a systematic review and meta-analysis. World Neurosurg 101:236–246
pubmed: 28104521
Soneru CP, Riley CA, Hoffman K, Tabaee A, Schwartz TH (2019) Intra-operative MRI vs endoscopy in achieving gross total resection of pituitary adenomas: a systematic review. Acta Neurochir 161(8):1683–1698
pubmed: 31139934
Bora SK, Suri A, Khadgawat R et al (2020) Management of Cushing’s disease: changing trend from microscopic to endoscopic surgery. World Neurosurg 134:e46–e54
pubmed: 31491582
Broersen LHA, Biermasz NR, van Furth WR, de Vries F, Verstegen MJT, Dekkers OM, Pereira AM (2018) Endoscopic vs. microscopic transsphenoidal surgery for Cushing’s disease: a systematic review and meta-analysis. Pituitary 21(5):524–534
pubmed: 29767319
pmcid: 6132967
Cebula H, Baussart B, Villa C et al (2017) Efficacy of endoscopic endonasal transsphenoidal surgery for Cushing’s disease in 230 patients with positive and negative MRI. Acta Neurochir 159(7):1227–1236
pubmed: 28281008
Sarkar S, Rajaratnam S, Chacko G, Mani S, Hesargatta AS, Chacko AG (2016) Pure endoscopic transsphenoidal surgery for functional pituitary adenomas: outcomes with Cushing’s disease. Acta Neurochir 158(1):77–86 discussion 86
pubmed: 26577636
Starke RM, Reames DL, Chen C-J, Laws ER, Jane JA (2013) Endoscopic transsphenoidal surgery for Cushing disease: techniques, outcomes, and predictors of remission. Neurosurgery 72(2):240–247 discussion 247
pubmed: 23149974
Babu H, Ortega A, Nuno M, Dehghan A, Schweitzer A, Bonert HV, Carmichael JD, Cooper O, Melmed S, Mamelak AN (2017) Long-term endocrine outcomes following endoscopic endonasal transsphenoidal surgery for acromegaly and associated prognostic factors. Neurosurgery 81(2):357–366
pubmed: 28368500
Gondim JA, Almeida JP, de Albuquerque LAF, Gomes E, Schops M, Ferraz T (2010) Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center. Neurosurg Focus 29(4):E7
pubmed: 20887132
Hazer DB, Işık S, Berker D, Güler S, Gürlek A, Yücel T, Berker M (2013) Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg 119(6):1467–1477
pubmed: 24074496
Kim JH, Hur KY, Lee JH et al (2017) Outcome of endoscopic transsphenoidal surgery for acromegaly. World Neurosurg 104:272–278
pubmed: 28465267
Lobo B, Heng A, Barkhoudarian G, Griffiths CF, Kelly DF (2015) The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: a 2014 perspective. Surg Neurol Int. https://doi.org/10.4103/2152-7806.157442
Paluzzi A, Gardner P, Fernandez-Miranda JC, Snyderman C (2012) The expanding role of endoscopic skull base surgery. Br J Neurosurg 26(5):649–661
pubmed: 22471243
Eseonu CI, ReFaey K, Rincon-Torroella J, Garcia O, Wand GS, Salvatori R, Quinones-Hinojosa A (2017) Endoscopic versus microscopic transsphenoidal approach for pituitary adenomas: comparison of outcomes during the transition of methods of a single surgeon. World Neurosurg 97:317–325
pubmed: 27742515
Kim JH, Lee JH, Lee JH, Hong AR, Kim YJ, Kim YH (2018) Endoscopic transsphenoidal surgery outcomes in 331 nonfunctioning pituitary adenoma cases after a single surgeon learning curve. World Neurosurg 109:e409–e416
pubmed: 29017983