“Cured” Prolactinoma Patients After Transsphenoidal Adenomectomy: Prediction of Recurrence

1989 ◽  
pp. 163-166
Author(s):  
E. Ciccarelli ◽  
E. Ghigo ◽  
L. Savino ◽  
C. Miola ◽  
A. Bertagna ◽  
...  
Keyword(s):  
Transsphenoidal Adenomectomy

Scalp hair loss after transsphenoidal adenomectomy in patients with acromegaly

2013 ◽  
Vol 79 (3) ◽  
pp. 386-393 ◽  
Author(s):  
Shozo Yamada ◽  
Noriaki Fukuhara ◽  
Hiroshi Nishioka ◽  
Mitsuo Yamaguchi-Okada ◽  
Akira Takeshita ◽  
...  
Keyword(s):  
Hair Loss ◽  
Scalp Hair ◽  
Transsphenoidal Adenomectomy

Evaluation of selective transsphenoidal adenomectomy by endocrinological testing and somatomedin-C measurement in acromegaly

1989 ◽  
Vol 70 (4) ◽  
pp. 561-567 ◽  
Author(s):  
Marco Losa ◽  
Reinhard Oeckler ◽  
Jochen Schopohl ◽  
O. Albrecht Müller ◽  
Julia Alba-Lopez ◽  
...  
Keyword(s):  
Tolerance Test ◽  
Oral Glucose ◽  
Slow Increase ◽  
Insulin Hypoglycemia ◽  
Somatomedin C ◽  
Content Type ◽  
Gh Secretion ◽  
Effective Form ◽  
Transsphenoidal Adenomectomy ◽  
Favorable Prognostic Factor

✓ A series of 29 previously untreated patients with acromegaly underwent transsphenoidal adenomectomy. Pre- and postoperative evaluation consisted of measuring growth hormone (GH) secretory dynamics during an oral glucose tolerance test (OGTT), the insulin hypoglycemia test, and the thyrotropin- and gonadotropin-releasing hormone (TRH/GnRH) test, and by obtaining the basal somatomedin-C level. After surgery, clinical and biochemical amelioration was achieved in all but two patients. In the whole group, basal GH and somatomedin-C levels decreased from a mean (± standard error of the mean) of 52.3 ± 12.7 to 11.1 ± 6.3 ng/ml and from 7.6 ± 0.7 to 2.5 ± 0.5 U/ml, respectively. Application of different criteria of cure revealed that 19 patients (66%) had basal GH levels below 5 ng/ml, 17 patients (59%) had normal somatomedin-C values, 16 patients (55%) had complete GH suppression (< 1 ng/ml) during OGTT, and 13 patients (45%) met the above-mentioned criteria with disappearance of the paradoxical GH response to TRH/GnRH test. Evaluation of GH secretion by insulin hypoglycemia testing was useless in assessing the outcome after neurosurgery. When only patients with a normal somatomedin-C level and complete GH suppressibility during OGTT were considered “cured,” the main favorable prognostic factor was intrasellar tumor localization, since 15 (75%) of 20 patients were “cured,” as opposed to only one (11%) of nine with extrasellar extension of the adenoma. During the follow-up period, no tumor recurrence was detected in any of the “cured” patients. In these subjects somatomedin-C levels remained stable in all except two patients, who showed a slow increase within the normal range of somatomedin-C concentration. These data confirm that transsphenoidal surgery is the most effective form of treatment in previously untreated acromegalic patients and that normalization of somatomedin-C levels reflects normal GH secretion. Measurement of somatomedin-C could replace more extensive endocrinological testing during monitoring of treated acromegalic patients.

Pituitary adenoma consistency is associated with postoperative hormonal deficits: a retrospective study on 50 patients undergoing transsphenoidal adenomectomy

2021 ◽  
Author(s):  
Alcubierre Dario De ◽  
Riccardo Pofi ◽  
Emilia Sbardella ◽  
Giulia Puliani ◽  
Valeria Hasenmajer ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pituitary Adenoma ◽  
Transsphenoidal Adenomectomy

RECURRENCE OF CUSHING'S DISEASE 10 YEARS AFTER TRANSSPHENOIDAL ADENOMECTOMY: REPORT OF A CASE

1996 ◽  
Vol 2 (3) ◽  
pp. 176-178
Author(s):  
Asumani S. Yeboah, MD ◽  
Joseph R. Tucci, MD, FACE
Keyword(s):  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Transsphenoidal Adenomectomy

Follow-up Management of Patients After Transsphenoidal Approach for Resection of Pituitary Adenomas

2019 ◽  
Vol 34 (2) ◽  
pp. 150-155
Author(s):  
Allison K. Ikeda ◽  
Lauren J. Luk ◽  
Zara M. Patel ◽  
Nelson M. Oyesiku ◽  
C. Arturo Solares ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Care Center ◽  
Tertiary Care ◽  
Cerebrospinal Fluid Leak ◽  
Patient Records ◽  
Tertiary Care Center ◽  
Postoperative Course ◽  
Transsphenoidal Adenomectomy ◽  
Fluid Leak

Background Endoscopic transsphenoidal adenomectomy (eTSA) is widely utilized for resection of pituitary adenoma. eTSA patients undergo healing for weeks to months and are potentially at risk for complications. Multidisciplinary follow-up monitoring is necessary. We hypothesized that patients with deviations from the routine postoperative course, broadly termed complications of interest (COI) in this study, following eTSA would increase the duration of follow-up in the rhinology clinic. Methods Retrospective review was performed on patients undergoing eTSA for pituitary adenoma from August 2007 to May 2016 at a single tertiary care center. COIs were reviewed for their influence on follow-up time. Results A total of 985 patient records were reviewed (mean age 51.0 ± 15.7 years, 55.2% female), of which, 21.1% of patients had a deviation from the expected postoperative course (7.0% rhinologic, 10.8% surgical, 0.6% perioperative medical, and 2.7% endocrinologic COIs). The most common COI was cerebrospinal fluid leak 5.6% (n = 55) followed by sinusitis 5.0% (n = 49). Moreover, 935 patients (94.9%) attended rhinology follow-up (172 patients with COI). For patients seen postoperatively by the rhinology service, COIs significantly increased the number of rhinologic follow-up visits (median 2 [interquartile range, IQR: 2–3] vs 3 visits [IQR: 2–4], P < .001), duration of rhinologic follow-up (median 54.0 days [IQR: 43.0–104.0] vs 88.0 days [IQR: 54.5–242.0], P < .001), and duration of overall multidisciplinary follow-up (median 354.0 days [IQR: 104.0–789.0] vs 537.0 days [IQR: 171.5–1313.5], P < .001), compared to those without COIs. Conclusions Patients who develop postoperative complications after eTSA have significantly extended follow-up with the multidisciplinary team.

Transsphenoidal adenomectomy for GH-, PRL- and ACTH-secreting pituitary tumours: outcome analysis in a series of 125 patients

2004 ◽  
Vol 25 (5) ◽  
pp. 251-256 ◽  
Author(s):  
V. Esposito ◽  
A. Santoro ◽  
G. Minniti ◽  
M. Salvati ◽  
G. Innocenzi ◽  
...  
Keyword(s):  
Outcome Analysis ◽  
Pituitary Tumours ◽  
Transsphenoidal Adenomectomy ◽  
Acth Secreting

Transsphenoidal adenomectomy for growth hormone-secreting pituitary adenomas in acromegaly: outcome analysis and determinants of failure

1993 ◽  
Vol 78 (2) ◽  
pp. 205-215 ◽  
Author(s):  
George T. Tindall ◽  
Nelson M. Oyesiku ◽  
Nelson B. Watts ◽  
Richard V. Clark ◽  
James H. Christy ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Outcome Analysis ◽  
Content Type ◽  
Transsphenoidal Adenomectomy ◽  
Postoperative Serum ◽  
Surgical Failure ◽  
Fine Print

✓ The results of transsphenoidal adenomectomy for growth hormone (GH)-secreting pituitary adenomas in acromegaly performed over a 17-year period were analyzed retrospectively to determine which preoperative factors significantly influenced the long-term surgical outcome. These variables were then used to develop a logistic regression model to determine the probability of surgical failure. The series consisted of 103 patients. Long-term follow-up study (mean duration 102 ± 64 months) was performed to derive outcome analysis and determinants of failure. Surgical control was defined as a long-term postoperative serum basal GH level of less than 5 µg/liter, a long-term postoperative serum somatomedin C (SM-C) level of less than 2.2 U/ml, and a favorable clinical response. Eighteen (17.5%) patients did not meet these criteria. The overall control rate by the GH criteria was 81.3% and by the SM-C criteria 76.2%. By multivariate logistic regression analysis, tumor stage was the strongest predictor of outcome (p < 0.05). The preoperative GH level, tumor grade, and preoperative SM-C level were significant univariate predictors (p < 0.05). There were statistically significant differences in mean preoperative GH and SM-C levels (p < 0.05, t-test) and tumor stage (p < 0.05, chi-squared test) between patients whose acromegaly was controlled by surgery and those whose acromegaly was not. Furthermore, estimates were derived of the probability of surgical failure based on preoperative GH level, preoperative SM-C level, and tumor grade and stage. The authors believe these findings will enhance clinical decision-making for neurosurgeons considering transsphenoidal microsurgery in patients with acromegaly.

Chronobiological aspects of headache syndromes due to sellar or pituitary pathology

Cephalalgia ◽  
1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 117-121
Author(s):  
Pierangelo Bossolo ◽  
Claudio Canepari ◽  
Mimma Maria Daguati ◽  
Alberto Cozzi ◽  
Marisa Fioravanti ◽  
...  
Keyword(s):  
Circadian Rhythms ◽  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Empty Sella ◽  
Circadian Rhythmicity ◽  
Circadian Pattern ◽  
Empty Sella Syndrome ◽  
Before And After ◽  
Transsphenoidal Adenomectomy ◽  
Adenoma Ipofisario

A chronobiological study was carried out in headache syndromes due to empty sella or to pituitary G.H.- and PRL-secreting adenomas. In the empty sella syndrome only the chrono-organization of G.H. secretion was disturbed, whereas pl. PRL exhibited the usual circadian pattern. The circadian rhythms of pl. G.H. and pl. PRL were abolished in G.H.-and PRL-secreting pituitary tumors, respectively, and were again detectable when patients were cured by selective transsphenoidal adenomectomy. A normal circadian rhythmicity of pl. cortisol was demonstrable in the empty sella syndrome and in pituitary adenomas, both before and after surgery. On a étudié les aspects rhythmométriques de certains cas de céphalée secondaire à un atteinte sellaire ou bien hypophysaire, tels la syndrome de la selle vide et les adénomes GH- ou PRL-secrétants. Au cours du syndrome de la selle vide on observe un trouble de la rhythmicité circadienne du GHpl., tandis que les autres rhythmes (PRL et cortisol pl., température orale) sont normaux. Dans les adénomes GH- ou PRL-secrétants on observe une altération sélective du rhythme circadien de l'hormone spécifiquement secrétée par l'adénome. Après l'exérèse chirurgicale de l'adénome par voie transphénoidale, la normalization des niveaux plasmatiques hormonaux s'accompagne à la réapparition du rhythme circadien habituel. Le rhythme circadien du cortisol plasmatique ne semble pas être affecté par la présence d'une selle vide ou bien d'un adénome GH- ou PRL-secrétant ni par l'adenomectomie par voie transphénoidale. E’ stata attuata una indagine cronobiologica in corso di cefalea secondaria a patologie sellario ipofisarie, quali la sindrome della sella vuota e gli adenomi GH- o PRL-secernenti, con sindrome cefalalgica. In presenza di empty sella si riscontra un'alterazione della cronoorganizzazione circadiana solo per la secrezione di G.H., mentre la PRL pl. presenta il normale ritmo circadiano. Negli adenomi ipofisari si rileva la scomparsa della normale ritmicità circadiana dell'ormone specificamente ipersecreto e la completa rimozione dell'adenoma per via trans-nasosfenoidale è seguita dal ripristino del ritmo circadiano dell'ormone stesso. Il ritmo circadiano del cortisolo pl. non risulta alterato nell'empty sella nè in presenza di adenoma ipofisario GH o PRL-secernente e non viene significativamente modificato dall'intervento neurochirurgico.

PITUITARY HORMONAL LOSS AND RECOVERY AFTER TRANSSPHENOIDAL ADENOMA REMOVAL

Neurosurgery ◽  
2008 ◽  
Vol 63 (4) ◽  
pp. 709-719 ◽  
Author(s):  
Nasrin Fatemi ◽  
Joshua R. Dusick ◽  
Carlos Mattozo ◽  
David L. McArthur ◽  
Pejman Cohan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Multivariate Analysis ◽  
Cerebrospinal Fluid Leak ◽  
Systemic Hypertension ◽  
Hormonal Status ◽  
Tumor Diameter ◽  
Multivariate Statistical ◽  
Hormonal Function ◽  
Transsphenoidal Adenomectomy ◽  
Fluid Leak

ABSTRACT OBJECTIVE Transsphenoidal adenomectomy carries the possibility of new pituitary failure and recovery. Herein, we present rates and determinants of postoperative hormonal status. METHODS All consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 8-year period were analyzed. Those with previous sellar radiotherapy were excluded. Pre- and postoperative hormonal status (at least 3 mo after surgery) were determined and correlated with clinical parameters using a multivariate statistical model. RESULTS Of 444 patients (median age 45 years, 75% macroadenoma, 19% with multiple operations), 9 had preoperative panhypopituitarism. Of the remaining 435 patients, new hypopituitarism occurred in 5.5% of patients (anterior loss in 5%; permanent diabetes insipidus in 2.1%; including 2 patients who had total hypophysectomy). Of 346 patients with preoperative hormonal dysfunction, 170 (49%) had improved function. “Stalk compression” hyperprolactinemia resolved in 73% of 133 patients; recovery of at least 1 other anterior axis (excluding isolated hypogonadism associated with “stalk compression” hyperprolactinemia) occurred in 24% of 209 patients. Multivariate analysis showed that new hypopituitarism was most strongly associated with larger tumor diameter (P = 0.04). Of 223 patients with an endocrine-inactive adenoma, new hypopituitarism was seen in 0, 7.2, and 13.6% of patients with tumor diameters of &lt;20, 20 to 29, and ≥30 mm, respectively (P = 0.005). Multivariate analysis revealed that resolution of hypopituitarism was related to younger age (39 versus 52 years, P &lt; 0.0001), absence of an intraoperative cerebrospinal fluid leak and, in patients with an endocrine-inactive adenoma, absence of systemic hypertension (24% versus 6%, P = 0.009). CONCLUSION After transsphenoidal adenomectomy, new unplanned hypopituitarism occurs in approximately 5% of patients, whereas improved hormonal function occurs in 50% of patients. The likelihood of new hormonal loss or recovery appears to depend on several factors. New hypopituitarism occurs most commonly in patients with tumors larger than 20 mm in size, whereas hormonal recovery is most likely to occur in younger, nonhypertensive patients and those without an intraoperative cerebrospinal fluid leak.

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