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Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience.

Marić A, Kruljac I, Čerina V, Pećina HI, Šulentić P, Vrkljan M - Croat. Med. J. (2012)

Bottom Line: Duration of empirical hydrocortisone replacement therapy was significantly shorter in microadenoma patients (P<0.001).Thirty-five percent of preoperatively present hormonal deficiencies improved after the surgery.Between tumor types there were no significant differences in remission, complications, and normal pituitary function recovery.

View Article: PubMed Central - PubMed

Affiliation: Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia.

ABSTRACT

Aim: To analyze early remission, complications, and pituitary function recovery after pure endoscopic endonasal transsphenoidal surgery (PEETS), a novel method in pituitary adenoma treatment.

Methods: Testing of all basal hormone values and magnetic resonance imaging (MRI) were performed preoperatively and postoperatively (postoperative MRI only in nonfunctioning adenomas) in 117 consecutive patients who underwent PEETS in the period between 2007 and 2010. The series consisted of 21 somatotroph adenomas, 61 prolactinomas, and 4 corticotroph and 31 nonfunctioning adenomas. Sixty-three were macroadenomas and 54 were microadenomas. Remission was defined as hormonal excess normalization on the seventh postoperative day in functioning adenomas and as normal MRI findings approximately four months postoperatively in nonfunctioning adenomas. The presence of hypogonadism, growth hormone deficiency, and hypothyroidism was assessed on the seventh postoperative day. Hypocortisolism was assessed through necessity for replacement therapy within 18 months postoperatively.

Results: Remission was achieved in 84% of patients: in 100% of microadenoma and 70% of macroadenoma patients (P<0.001, odds ratio [OR], 28.16, 95% confidence interval [CI], 1.61-491.36), respectively. Endocrinological complications occurred in 17.1% of patients: in 9% of microadenoma and 24% of macroadenoma patients (P=0.049, OR, 3.06; 95% CI, 1.03-9.08). Duration of empirical hydrocortisone replacement therapy was significantly shorter in microadenoma patients (P<0.001). Thirty-five percent of preoperatively present hormonal deficiencies improved after the surgery. Between tumor types there were no significant differences in remission, complications, and normal pituitary function recovery.

Conclusion: Patients with microadenomas had higher remission and lower complication rates following PEETS, emphasizing the necessity for early detection and treatment of pituitary adenomas. PEETS is a discussion-worthy method for microprolactinoma treatment.

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Related in: MedlinePlus

Hormonal deficiencies before (open bars) and after (closed bars) pure endoscopic endonasal transsphenoidal surgery in patients with macroadenomas.GH – growth hormone.
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Figure 1: Hormonal deficiencies before (open bars) and after (closed bars) pure endoscopic endonasal transsphenoidal surgery in patients with macroadenomas.GH – growth hormone.

Mentions: Since there were no hormonal deficiencies in patients with microadenomas, hypopituitarism improvement was analyzed in macroadenoma patients. There were 85 hormonal deficiencies recorded in 63 patients. Improvement was recorded in 35.3% (30/85) of hormonal deficiencies. Preoperatively, hypogonadism was recorded in 50.8% (32/63), growth hormone deficiency in 41.3% (26/63), adrenal insufficiency in 30.2% (19/63), and hypothyroidism in 12.7% (8/63) of patients. Hormonal deficiency improved in 26.7% (8/30) of patients with hypogonadism, 50.0% (13/26) with growth hormone deficiency, 42.1% (8/19) with adrenal insufficiency, and 12.5% with hypothyroidism (1/8) (Figure 1). Hypogonadism was recorded in 10/22 prolactinoma patients and improved in two patients. GH deficiency was recorded in 5/22 and improved in three patients, while hypocortisolism was recorded in five and improved in three patients. Hypogonadism was present in three macrosomatotropinoma patients and improved in one patient. Hypocortisolism was recorded in two and improved in one patient. A total of 60 hormonal deficiencies were recorded in 28 patients with nonfunctioning macroadenomas preoperatively. There were 19 cases of hypogonadism, which improved in 5 (26.3%) patients. Growth hormone deficiency improved in 47.6% (10/21), adrenal insufficiency in 33.3% (4/12), and hypothyroidism in 12.5% (1/8) of patients.


Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience.

Marić A, Kruljac I, Čerina V, Pećina HI, Šulentić P, Vrkljan M - Croat. Med. J. (2012)

Hormonal deficiencies before (open bars) and after (closed bars) pure endoscopic endonasal transsphenoidal surgery in patients with macroadenomas.GH – growth hormone.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368296&req=5

Figure 1: Hormonal deficiencies before (open bars) and after (closed bars) pure endoscopic endonasal transsphenoidal surgery in patients with macroadenomas.GH – growth hormone.
Mentions: Since there were no hormonal deficiencies in patients with microadenomas, hypopituitarism improvement was analyzed in macroadenoma patients. There were 85 hormonal deficiencies recorded in 63 patients. Improvement was recorded in 35.3% (30/85) of hormonal deficiencies. Preoperatively, hypogonadism was recorded in 50.8% (32/63), growth hormone deficiency in 41.3% (26/63), adrenal insufficiency in 30.2% (19/63), and hypothyroidism in 12.7% (8/63) of patients. Hormonal deficiency improved in 26.7% (8/30) of patients with hypogonadism, 50.0% (13/26) with growth hormone deficiency, 42.1% (8/19) with adrenal insufficiency, and 12.5% with hypothyroidism (1/8) (Figure 1). Hypogonadism was recorded in 10/22 prolactinoma patients and improved in two patients. GH deficiency was recorded in 5/22 and improved in three patients, while hypocortisolism was recorded in five and improved in three patients. Hypogonadism was present in three macrosomatotropinoma patients and improved in one patient. Hypocortisolism was recorded in two and improved in one patient. A total of 60 hormonal deficiencies were recorded in 28 patients with nonfunctioning macroadenomas preoperatively. There were 19 cases of hypogonadism, which improved in 5 (26.3%) patients. Growth hormone deficiency improved in 47.6% (10/21), adrenal insufficiency in 33.3% (4/12), and hypothyroidism in 12.5% (1/8) of patients.

Bottom Line: Duration of empirical hydrocortisone replacement therapy was significantly shorter in microadenoma patients (P<0.001).Thirty-five percent of preoperatively present hormonal deficiencies improved after the surgery.Between tumor types there were no significant differences in remission, complications, and normal pituitary function recovery.

View Article: PubMed Central - PubMed

Affiliation: Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia.

ABSTRACT

Aim: To analyze early remission, complications, and pituitary function recovery after pure endoscopic endonasal transsphenoidal surgery (PEETS), a novel method in pituitary adenoma treatment.

Methods: Testing of all basal hormone values and magnetic resonance imaging (MRI) were performed preoperatively and postoperatively (postoperative MRI only in nonfunctioning adenomas) in 117 consecutive patients who underwent PEETS in the period between 2007 and 2010. The series consisted of 21 somatotroph adenomas, 61 prolactinomas, and 4 corticotroph and 31 nonfunctioning adenomas. Sixty-three were macroadenomas and 54 were microadenomas. Remission was defined as hormonal excess normalization on the seventh postoperative day in functioning adenomas and as normal MRI findings approximately four months postoperatively in nonfunctioning adenomas. The presence of hypogonadism, growth hormone deficiency, and hypothyroidism was assessed on the seventh postoperative day. Hypocortisolism was assessed through necessity for replacement therapy within 18 months postoperatively.

Results: Remission was achieved in 84% of patients: in 100% of microadenoma and 70% of macroadenoma patients (P<0.001, odds ratio [OR], 28.16, 95% confidence interval [CI], 1.61-491.36), respectively. Endocrinological complications occurred in 17.1% of patients: in 9% of microadenoma and 24% of macroadenoma patients (P=0.049, OR, 3.06; 95% CI, 1.03-9.08). Duration of empirical hydrocortisone replacement therapy was significantly shorter in microadenoma patients (P<0.001). Thirty-five percent of preoperatively present hormonal deficiencies improved after the surgery. Between tumor types there were no significant differences in remission, complications, and normal pituitary function recovery.

Conclusion: Patients with microadenomas had higher remission and lower complication rates following PEETS, emphasizing the necessity for early detection and treatment of pituitary adenomas. PEETS is a discussion-worthy method for microprolactinoma treatment.

Show MeSH
Related in: MedlinePlus