Surgical Treatment of Clinically Nonsecreting Pituitary Adenomas in Elderly Patients

Neurosurgery ◽  
2000 ◽  
Vol 47 (4) ◽  
pp. 843-849 ◽  
Author(s):  
Masamichi Kurosaki ◽  
Dieter K. Lüdecke ◽  
Jörg Flitsch ◽  
Wolfgang Saeger
Keyword(s):  
Growth Hormone ◽  
Surgical Treatment ◽  
Elderly Patients ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Serum Prolactin ◽  
Safe Procedure ◽  
Duration Of Symptoms ◽  
Average Hospital ◽  
Visual Disturbances

Abstract OBJECTIVE The goal of this study was to evaluate the efficacy and safety of transsphenoidal pituitary surgery for elderly patients, using improved techniques of the past decade. METHODS We retrospectively analyzed 32 surgically treated cases of clinically nonsecreting pituitary adenomas in patients more than 70 years of age (mean, 73.9 ± 3.4 yr). These patients were identified in a review of 982 patients with pituitary adenomas who were treated at University Hospital Eppendorf, Hamburg, between January 1991 and November 1999. RESULTS The mean preoperative duration of symptoms was 1.9 years (2 wk to 11 yr). The chiasmatic syndrome was present for 27 patients (84.4%). All patients underwent transsphenoidal surgery. Seven patients underwent reoperations. Preoperative assessments of anterior pituitary function revealed growth hormone deficiencies for 21 of 27 patients (77.8%), thyroid insufficiencies for 10 of 30 patients (33.3%), and adrenal insufficiencies for 13 of 29 patients (44.8%). Hypogonadism and hyperprolactinemia were observed for 76.7% and 46.9% of the patients, respectively. All tumors were macroadenomas, ranging from 18 to 50 mm (average, 33.6 mm) in size, including 7 enclosed and 25 invasive adenomas. Complete microscopic tumor resection was achieved in 24 cases, and subtotal removal was performed in 8 cases. There were no severe perioperative complications. In the cases involving hyperprolactinemia, serum prolactin levels were normalized for 8 of 11 patients (72.7%). Normal thyroid function was recovered for 1 of 10 patients (10.0%) with preoperative hypothyroidism. However, growth hormone or adrenal insufficiencies persisted for all patients with preoperative insufficiencies. Visual disturbances were improved for 19 of 23 patients (82.6%). All patients recovered well after surgery, with an average hospital stay of 16.3 days. Histological and immunohistochemical studies demonstrated gonadotroph adenomas in 56.7% of cases, null-cell adenomas in 26.7%, and oncocytomas in 13.3%. CONCLUSION Surgical treatment of nonsecreting pituitary adenomas causing visual disturbances is standard, even for elderly patients. In this series, transsphenoidal surgery was a safe procedure, with minimal morbidity and excellent tolerance. Age alone is not a contraindication for active treatment, particularly with transsphenoidal surgery.

scholarly journals SURG-08. SURGICAL OUTCOMES OF PITUITARY ADENOMAS TREATED WITH TRANSSPHENOIDAL SURGERY: A SINGLE INSTITUTION’S EXPERIENCE

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi241-vi241
Author(s):  
Young Beom Seo ◽  
Oh-Lyong Kim
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Time Interval ◽  
Tumor Type ◽  
Visual Disturbances

Abstract We retrospectively analyzed surgical outcomes of transsphenoidal surgery for pituitary adenomas. A total of 366 consecutive patients undergoing transsphenoidal surgery for a pituitary adenoma from December 1990 through May 2017 were included in this study. The most common tumor type was nonfunctioning pituitary adenoma (NFPA) (63.7%), followed by prolactin-secreting adenoma (20.5%), growth hormone-secreting adenoma (13.4%), adrenocorticotropin-secreting adenoma (2.2%), and thyrotropin-secreting adenoma (0.2%). This cohort study consisted of 164 male and 202 female patients. The median patients age was 48 years. The median follow-up duration was 63 months. Gross-total resection (GTR) was achieved in 83.7% of patients with a NFPA, 76% of prolactin-secreting adenomas, 71.4% of growth hormone-secreting adenomas, 75% of adrenocorticotropin-secreting adenomas, 100% of thyrotropin-secreting adenomas. There were 326 macroadenomas (69.1%). Surgical outcome was better in patients with microadenomas than in patients with macroadenomas (100% and 77.9%, respectively). Improvement of visual disturbances occurred in 148 (93.7%) of the 158 cases. Hormonal impairment by pituitary adenoma was improved in 105 (87.5%) of the 120 cases. There were 24 (8.2%) cases of recurrence after GTR; 17 patients underwent second surgery, 5 patients received radiotherapy, and the others continued conservative treatment. The median time interval between TSA and recurrence was 56 months. Postoperative cerebrospinal fluid leakage occurred in seven (1.9%) of 366 patients. Transsphenoidal surgery is an effective and safe treatment modality for most patients with pituitary adenoma.

Transsphenoidal Surgery for Growth Hormone–Secreting Pituitary Adenomas in 130 Patients

2014 ◽  
Vol 81 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Manouchehr Shirvani ◽  
Rouzbeh Motiei-Langroudi
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery

Restoration of oestrogen-positive feedback effect on LH release in women with prolactinoma by transsphenoidal surgery

1982 ◽  
Vol 100 (4) ◽  
pp. 492-498 ◽  
Author(s):  
Koji Koike ◽  
Toshihiro Aono ◽  
Hirohisa Tsutsumi ◽  
Akira Miyake ◽  
Keiichi Kurachi
Keyword(s):  
Surgical Treatment ◽  
Positive Feedback ◽  
Transsphenoidal Surgery ◽  
Feedback Effect ◽  
Serum Prolactin ◽  
Luteinizing Hormone Releasing Hormone ◽  
Serum Lh ◽  
Lh Release ◽  
The Mean ◽  
Positive Feedback Effect

Abstract. The effect of hyperprolactinaemia on the hypothalamo-pituitary axis was assessed by iv injection of 100 μg luteinizing hormone releasing hormone (LRH) in 7 women with prolactinoma before and 3 months after normalization of the Prl level by transsphenoidal surgery. A dose of 20 mg of conjugated oestrogen (Premarin®) was also injected iv into patients with prolactinoma before and 4 months after surgery, and the serum LH levels were determined serially for 120 h after the injection. Surgical treatment caused significant reduction of the mean (± se) serum prolactin (Prl) level from 123.3 ± 7.8 to 19.4 ± 5.6 ng/ml. But the differences in the basal levels of LH (11.3 ± 2.2 to 8.6 ± 1.5 mIU/ml), FSH (8.3 ± 2.4 to 10.6 ± 3.7 mIU/ml) and oestradiol (26.6 ± 8.6 to 37.5 ± 5.5 pg/ml) before and 4 months after surgery were not significant. An exaggerated LH response to LRH in untreated prolactinoma patients was also observed after surgical treatment. After surgical treatment, patients showed LH release with a peak between 48 and 72 h after the injection of Premarin, whereas before treatment they did not show any LH discharge. The mean percent increase in LH between 48 and 72 h was also significantly higher after operation than before operation. These results suggest that the hyperprolactinaemia in prolactinoma patients may cause an impaired positive feedback effect of oestrogen on LH release and that this derangement can be reversed by reduction of the Prl level by adenomectomy.

scholarly journals Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes

2019 ◽  
Vol 131 (1) ◽  
pp. 147-153 ◽  
Author(s):  
Jonathan Rick ◽  
Arman Jahangiri ◽  
Patrick M. Flanigan ◽  
Ankush Chandra ◽  
Sandeep Kunwar ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Logistic Regression ◽  
Pituitary Adenomas ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Serum Prolactin ◽  
Tumor Diameter ◽  
Multiple Logistic Regression ◽  
Clinical Presentations

OBJECTIVEAcromegaly results in disfiguring growth and numerous medical complications. This disease is typically caused by growth hormone (GH)–secreting pituitary adenomas, which are treated first by resection, followed by radiation and/or medical therapy if needed. A subset of acromegalics have dual-staining pituitary adenomas (DSPAs), which stain for GH and prolactin. Presentations and treatment outcomes for acromegalics with DSPAs are not well understood.METHODSThe authors retrospectively reviewed the records of more than 5 years of pituitary adenomas resected at their institution. Data were collected on variables related to clinical presentation, tumor pathology, radiological size, and disease recurrence. The Fisher’s exact test, ANOVA, Student t-test, chi-square test, and Cox proportional hazards and multiple logistic regression were used to measure statistical significance.RESULTSOf 593 patients with pituitary adenoma, 91 presented with acromegaly. Of these 91 patients, 69 (76%) had tumors that stained for GH only (single-staining somatotrophic adenomas [SSAs]), while 22 (24%) had tumors that stained for GH and prolactin (DSPAs). Patients with DSPAs were more likely to present with decreased libido (p = 0.012), signs of acromegalic growth (p = 0.0001), hyperhidrosis (p = 0.0001), and headaches (p = 0.043) than patients with SSAs. DSPAs presented with significantly higher serum prolactin (60.7 vs 10.0 µg/L, p = 0.0002) and insulin-like growth factor-1 (IGF-1) (803.6 vs 480.0 ng/ml, p = 0.0001), and were more likely to have IGF-1 levels > 650 ng/ml (n = 13 [81.3%] vs n = 6 [21.4%], p = 0.0001) than patients with SSAs despite similar sizes (1.8 vs 1.7 cm, p = 0.5). Patients with DSPAs under 35 years of age were more likely to have a recurrence (n = 4 [50.0%] vs n = 3 [11.1%], p = 0.01) than patients with SSAs under the age of 35. DSPA patients were less likely to achieve remission with surgery than SSA patients (n = 2 [20%] vs n = 19 [68%], p = 0.01). Univariate analysis identified single-staining tumors (p = 0.02), gross-total resection (p = 0.02), and tumor diameter (p = 0.05) as predictors of surgical remission. Multiple logistic regression demonstrated that SSAs (p = 0.04) were independently associated with surgical remission of acromegaly. Kaplan-Meier analysis revealed that DSPAs had more time until disease remission (p = 0.033).CONCLUSIONSAcromegalics with tumors that stain for prolactin and GH, which represented almost a quarter of acromegalics in this cohort, had more aggressive clinical presentations and postoperative outcomes than SSAs. Prolactin staining provides useful information for acromegalics undergoing pituitary surgery.

Endoscopic endonasal transsphenoidal surgery: experience with 50 patients

1997 ◽  
Vol 87 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Hae-Dong Jho ◽  
Ricardo L. Carrau
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Elevated Serum ◽  
Cushing's Disease ◽  
Serum Prolactin ◽  
Subtotal Resection ◽  
Operating Microscope ◽  
Endoscopic Endonasal

✓ An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization. This study focuses on 50 patients (28 females and 22 males) with a median age of 38 years (range 14–88 years). Initially, four patients underwent operation via a sublabial—transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormonesecreting adenomas (eight patients with Cushing's disease and 17 patients with prolactinomas). Among the eight patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with prolactinomas, 10 improved clinically with normal serum prolactin levels, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

scholarly journals Influence of Variables on Hormone Profile in Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

2019 ◽  
Vol 29 (3) ◽  
pp. 508-516
Author(s):  
Fernando Simões Nazareno ◽  
Rodrigo Alves de Carvalho Cavalcante ◽  
Tiago Vinicius Silva Fernandes ◽  
Osvaldo Vilela Garcia Filho
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Medical Records ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Total Population ◽  
Transsphenoidal Approach ◽  
Endoscopic Transsphenoidal Surgery ◽  
Grade Method ◽  
Hormone Profile

Objective: to evaluate the hormone profiles of patients with pituitary adenomas operated on in Hospital das Clínicas, UniversidadeFederal de Goiás (HC-UFG), correlating them with the variables age, sex, and Knosp grade. Method: This is a retrospective quantitativestudy of medical records, including a total population of 20 patients diagnosed with pituitary adenomas operated on using the pureendoscopic endonasal transsphenoidal approach. The hormone profiles of the three types of pituitary adenoma prevalent in this institutionwere analyzed: nonfunctioning macroadenoma, growth hormone-secreting pituitary adenoma (acromegaly), and adrenocorticotropichormone-secreting pituitary adenoma (Cushing’s disease). Pre and postoperative hormone values were statistically paired with thevariables selected. Results: The global levels of the specific hormones of each disease decreased after surgery. However, no statisticalsignificance was found between the variables selected in this study and the pre and postoperative hormone values. Conclusion:The main surgical goal, the specific hormones decrease, was achieved in all the surgeries performed. Analyzing the relationshipbetween the variables and the hormone profiles, we conclude that age, sex, and Knosp grade did not influence the results obtained.

EVALUATION THE SURGICAL TREATMENT OF HEMORRHOID DISEASE BY TRANSANAL HEMORRHOIDAL DEARTERIALISATION (THD)

2013 ◽  
pp. 76-82
Author(s):  
Van Lieu Nguyen ◽  
Doan Van Phu Nguyen ◽  
Thanh Phuc Nguyen
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Mucosal Prolapse ◽  
Safe Procedure ◽  
Average Hospital ◽  
Rectal Mucosal Prolapse ◽  
Internal Hemorrhoids ◽  
Grade Iii

Introduction: Since 2006 Transanal hemorrhoidal dearterialization (THD), as a Doppler - guided Minimally Invasive Therapeutic Approach to Hemorrhoids, has been widely applied in European countries, America owing to its remarkable advantages over other surgical procedures such as less postoperative pain, shorter length of hospital stay, absence of serious complications, sooner recovery after surgery. Therefore, it has been widely indicated and accepted by surgeons. In Hue, THD has been implemented since April 2013. So far, this procedure has been in more or less common use to treat grade III and IV internal hemorrhoids with or without rectal mucosal prolapse. Method: From April 2013 through September 2013, 79 patients with grade III and IV hemorrhoids with or without rectal mucosal prolapse were treated by means of THD. During the study, postoperative complications, pains, hospital stay and patient’s satisfaction were monitored. Systematic follow-up of patients after surgery were carried out regularly 1 month and 3 months after surgery. Results: With 79 patients with grade III and IV hemorrhoids with or without rectal mucosal prolapse treated with THD, the following results were obtained: (i) THD was performed on 48 (60.8%) male patients, 31 (39.2%) female patients, mean age of 48.7±22.5 years; the youngest 18 and oldest 81 years old; (ii) Average hospital stay was 2.12 ± 1.25 days, the shortest stay 1 day and the longest 5 days. No surgical complications was reported. No serious postoperative complications was reported; (iii) Postoperative pains were found mild in 65 patients (82.2%), moderate in 13 patients (16.5%), and severe in 1 patient (1.3%). No case of postoperative urinary retention was recorded; (iv) Follow-up 1 month after surgery: good results in 71 patients (94.6%) patients, satisfactory results in 4 patients (5.4%) patients; (v) Follow-up 3 months after surgery: good results in 40 (95.2%) patients, satisfactory results in 2 patients (4.8%). Conclusion: Our research shows that surgical treatment of hemorrhoids with THD proves to be a safe procedure, causing less postoperative pains, shorter hospital stay and sooner resumption of work. Key words: Hemorrhoid disease, transanal hemorrhoidal dearterialisation (THD).

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