Early Surgical Intervention in Non-Functioning Pituitary Macroadenomas in adult patients Without Optic Apparatus compression, Should We Consider It? - a matched case-control study.

indications for surgery. non- functioning pituitary macroadenomas optic apparatus compression surgical intervention

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
03 Sep 2024
Historique:
received: 16 04 2024
revised: 27 08 2024
accepted: 28 08 2024
medline: 6 9 2024
pubmed: 6 9 2024
entrez: 5 9 2024
Statut: aheadofprint

Résumé

Surgical decompression is the recommended treatment for patients with non-functioning pituitary macroadenomas (NFPMAs) with associated visual impairment. Other relative indications for surgery include endocrinopathies, craniopathies, and headaches. Nevertheless, patients without those 'classical indications' who would otherwise be considered asymptomatic with regards to the NFPMAs, and treated conservatively with clinical radiological surveillance, may suffer higher rates of other morbidities related to the NFPMAs. We aimed to evaluate the prevalence of newly diagnosed comorbidities in conservatively treated patients with NFPMAs. We reviewed the medical records of 55 patients with NFPMAs from 2012-2022 who lacked classical indications for surgery at diagnosis. During the follow-up period we searched for any of the following potentially associated newly reported symptoms and signs: headache, dizziness, syncope, GI symptoms, hyponatremia, falls, weakness and general deterioration, CVA related, and endocrine-related including DM-2. Patients were compared to a matched control group. Cohort patients were further analyzed to discover specific endocrine axes deficiencies, and tumor volumes were measured using MRI scans at diagnosis. 55 patients were included in the final cohort. NFPMAs were associated with the development of newly diagnosed headaches, hypertension and Hypopituitarism. Other symptoms associated with NFPMAs included - dizziness, syncope/pre-syncope, GI-related symptoms, hyponatremia, general weakness and falls, infectious-related symptoms. Average associated ER visits in this group were higher compared to the control group. These results may suggest the advantages of early surgical intervention for NFPMAs to mitigate comorbidities and improve health-related quality of life.

Sections du résumé

BACKGROUND BACKGROUND
Surgical decompression is the recommended treatment for patients with non-functioning pituitary macroadenomas (NFPMAs) with associated visual impairment. Other relative indications for surgery include endocrinopathies, craniopathies, and headaches. Nevertheless, patients without those 'classical indications' who would otherwise be considered asymptomatic with regards to the NFPMAs, and treated conservatively with clinical radiological surveillance, may suffer higher rates of other morbidities related to the NFPMAs. We aimed to evaluate the prevalence of newly diagnosed comorbidities in conservatively treated patients with NFPMAs.
METHODS METHODS
We reviewed the medical records of 55 patients with NFPMAs from 2012-2022 who lacked classical indications for surgery at diagnosis. During the follow-up period we searched for any of the following potentially associated newly reported symptoms and signs: headache, dizziness, syncope, GI symptoms, hyponatremia, falls, weakness and general deterioration, CVA related, and endocrine-related including DM-2. Patients were compared to a matched control group. Cohort patients were further analyzed to discover specific endocrine axes deficiencies, and tumor volumes were measured using MRI scans at diagnosis.
RESULTS RESULTS
55 patients were included in the final cohort. NFPMAs were associated with the development of newly diagnosed headaches, hypertension and Hypopituitarism. Other symptoms associated with NFPMAs included - dizziness, syncope/pre-syncope, GI-related symptoms, hyponatremia, general weakness and falls, infectious-related symptoms. Average associated ER visits in this group were higher compared to the control group.
CONCLUSIONS CONCLUSIONS
These results may suggest the advantages of early surgical intervention for NFPMAs to mitigate comorbidities and improve health-related quality of life.

Identifiants

DOI: 10.1016/j.wneu.2024.08.151 PMID: 39236806
pubmed: 39236806
pii: S1878-8750(24)01519-5
doi: 10.1016/j.wneu.2024.08.151
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Elsevier Inc. All rights reserved.

Auteurs

Yuval Sufaro (Y)

Department of Neurosurgery, Soroka University Medical Center, Beer- Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Moshe Shmueli (M)

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel. Electronic address: Mosheshm@post.bgu.ac.il.

Elad Avraham (E)

Department of Neurosurgery, Soroka University Medical Center, Beer- Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Nave Paran (N)

Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.

Talya Blumkine (T)

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Israel Melamed (I)

Department of Neurosurgery, Soroka University Medical Center, Beer- Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Merav Frenkel (M)

Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Endocrinology, Soroka University Medical Center, Beer- Sheva, Israel.

Amit Azriel (A)

Department of Neurosurgery, Soroka University Medical Center, Beer- Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Classifications MeSH