In-Hospital Postoperative Complications in Patients With Pituitary Adenoma Who Underwent Pituitary Surgery From January 2010 to December 2015: A Multicenter Study

Abstract Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

Download Full-text

Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02207-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Inge van den Berg ◽

Robert R. J. Coebergh van den Braak ◽

Jeroen L. A. van Vugt ◽

Jan N. M. Ijzermans ◽

Stefan Buettner

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Multicenter Study ◽

Survival Data ◽

Standard Therapy ◽

Tumor Grade ◽

National Registry ◽

Stage I ◽

Stage Iii ◽

Curative Intent

Abstract Background Colorectal cancer is the third most common type of cancer in the world. We characterize a cohort of patients who survived up to 5 years without recurrence and identify factors predicting the probability of cure. Methods We analyzed data of patients who underwent curative intent surgery for stage I–III CRC between 2007 and 2012 and who had had been included in a large multicenter study in the Netherlands. Cure was defined as 5-year survival without recurrence. Survival data were retrieved from a national registry. Results Analysis of data of 754 patients revealed a cure rate of 65% (n = 490). Patients with stage I disease and T1- and N0-tumor had the highest probability of cure (94%, 95% and 90%, respectively). Those with a T4-tumor or N2-tumor had the lowest probability of cure (62% and 50%, respectively). A peak in the mortality rate for older patients early in follow-up suggests early excess mortality as an explanation. A similar trend was observed for stage III disease, poor tumor grade, postoperative complications, sarcopenia, and R1 resections. Patients with stage III disease, poor tumor grade, postoperative complications, sarcopenia, and R1 resections show a similar trend for decrease in CSS deaths over time. Conclusion In the studied cohort, the probability of cure for patients with stage I–III CRC ranged from 50 to 95%. Even though most patients will be cured from CRC with standard therapy, standard therapy is insufficient for those with poor prognostic factors, such as high T- and N-stage and poor differentiation grade.

Download Full-text

Postoperative complications and quality of life in patients with pituitary adenoma

Gland Surgery ◽

10.21037/gs-20-690 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1521-1529

Author(s):

Jiajia Zhang ◽

Ya Wang ◽

Xiuqun Xu ◽

Yudan Gu ◽

Fei Huang ◽

...

Keyword(s):

Quality Of Life ◽

Pituitary Adenoma ◽

Postoperative Complications

Download Full-text

Challenging diagnosis of resistance to thyroid hormone in a patient with pituitary adenoma

BMJ Case Reports ◽

10.1136/bcr-2019-229430 ◽

2019 ◽

Vol 12 (7) ◽

pp. e229430

Author(s):

Nelson Carvalho Cunha ◽

Leonor Gomes ◽

Margarida Bastos

Keyword(s):

Pituitary Adenoma ◽

Thyroid Hormone ◽

Correct Diagnosis ◽

Pituitary Surgery ◽

Pituitary Hormones ◽

Young Female ◽

Left Lobe ◽

Antithyroid Drugs ◽

Resistance To Thyroid Hormone ◽

Normal Ranges

The elevation of thyroid hormone with a normal or elevated thyroid-stimulation hormone (TSH) occurs uncommonly. This set a diagnosis challenge between TSH-secreting pituitary adenoma and resistance to thyroid hormone (RTH). We report a case of a young female patient with palpitations, with elevated thyroid hormone and non-suppressed TSH. TSH receptor antibody was undetectable. Thyroid ultrasound revealed mild heterogeneous goitre, and MRI revealed a microadenoma with 7.5 mm length in pituitary’s left lobe. Pituitary hormones were within normal ranges. The thyrotropin-releasing hormone stimulation test showed normal TSH elevation, consistent with RTH. The genetic test revealed a mutation in heterozygosity in THRB gene (G344R) confirming RTH-beta. No pituitary surgery or thyroidectomy was performed nor were prescribed any antithyroid drugs. Inappropriate secretion of TSH requires a high level of clinical suspicion and the proper laboratory, genetic and radiological studies to conduct a correct diagnosis and prevent unnecessary and potential harmful therapies.

Download Full-text

Which factors predict the results of pituitary surgery in acromegaly?

Acta Endocrinologica ◽

10.1530/acta.0.1170491 ◽

1988 ◽

Vol 117 (4) ◽

pp. 491-496 ◽

Cited By ~ 15

Author(s):

W. J. G. Oyen ◽

G. F. F. M. Pieters ◽

E. Meijer ◽

J. v. Laarhoven ◽

A. G. H. Smals ◽

...

Keyword(s):

Pituitary Adenoma ◽

Predictive Factors ◽

Pituitary Surgery ◽

Sex Distribution ◽

Normal Range ◽

Somatomedin C ◽

Group A ◽

Operation Group ◽

Group B ◽

Suprasellar Extension

Abstract. Thirty-one patients with acromegaly who underwent pituitary surgery were investigated for possible predictive factors of the surgical outcome. The patients were divided into two groups: those whose GH levels normalized (<5 μg/l) after operation, group A (N = 18), and those whose GH levels remained elevated, group B (N = 13). There were no differences in age, sex distribution and sellar volume between both groups. There was a tendency to a higher incidence of suprasellar extension of the pituitary tumor in group B (P < 0.10). The basal GH levels in group A (38 ± 5 μg/l) before operation were significantly lower than in group B (100 ± 22 μg/l, P < 0.002). Somatomedin C levels after the operation were significantly lower in group A than in group B (P < 0.05) and were more often in the normal range (P < 0.05). No differences were found in the occurrence of paradoxical GH responses to TRH and/or to GnRH between the groups and neither were there any differences in GH responses to GHRH and to bromocriptine between the groups. The sensitivity to SRIH tended to be higher in group A. After operation, the paradoxical GH response to TRH disappeared in 7 out of 10 patients and to GnRH in 2 out of 5 patients of group A, whereas in group B this anomaly persisted in all 9 after TRH and all 3 patients after GnRH. Hypopituitarism developed in only 5 out of the 31 patients. We conclude that the basal GH level is a factor that to a large extent may predict the effect of pituitary surgery in acromegaly. However, despite normalization of the basal GH level, paradoxical responses to TRH and or GnRH persist in a minority of the cured patients, indicating the presence of remnants of the pituitary adenoma.

Download Full-text

Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

Saudi Journal of Anaesthesia ◽

10.4103/1658-354x.136424 ◽

2014 ◽

Vol 8 (3) ◽

pp. 335 ◽

Cited By ~ 12

Author(s):

Tumul Chowdhury ◽

Hemanshu Prabhakar ◽

ParmodK Bithal ◽

Bernhard Schaller ◽

HariHara Dash

Keyword(s):

Postoperative Complications ◽

Prospective Study ◽

Pituitary Surgery ◽

Transsphenoidal Pituitary Surgery ◽

A Prospective Study

Download Full-text

Cerebrospinal Fluid Leak during Stapes Surgery: Gushing Leaks and Oozing Leaks, Two Different Phenomena

Ear Nose & Throat Journal ◽

10.1177/014556131709600817 ◽

2017 ◽

Vol 96 (8) ◽

pp. 302-308 ◽

Cited By ~ 2

Author(s):

Juan Luis Quesada ◽

Giovanni Cammaroto ◽

Lilla Bonanno ◽

Francesco Galletti ◽

Pedro Quesada

Keyword(s):

Cerebrospinal Fluid ◽

Statistical Analysis ◽

Postoperative Complications ◽

Multicenter Study ◽

Cerebrospinal Fluid Leak ◽

Stapes Surgery ◽

Csf Leak ◽

Clinical Evaluations ◽

Hearing Outcomes ◽

Fluid Leak

Cerebrospinal fluid (CSF) leak is an uncommon event that can occur during stapes surgery. Such leaks can be classified as gushing leaks (stapes gushers) and oozing leaks. A stapes gusher is a massive flow of CSF through the perforated footplate that fills the middle ear suddenly, while an oozing leak is a slower and less profuse flow. We conducted a retrospective, observational, multicenter study of 38 patients—23 men and 15 women, aged 23 to 71 years (mean: 47)—who had experienced a CSF leak during stapes surgery. Patients were divided into various groups according to the type of surgical procedure performed and the type of postoperative complications they experienced. Audiometric and clinical evaluations were carried out pre- and postoperatively. Correlations among surgical variations (total or partial stapedectomy, placement of a prosthesis), hearing outcomes, and the incidence of postoperative complications (postoperative CSF leak and vertigo) were studied. Our statistical analysis revealed that gushing leaks and oozing leaks result in different degrees of hearing impairment and different rates of complications. We recommend that an individual approach be used to manage these complications.

Download Full-text

Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

Journal of Enam Medical College ◽

10.3329/jemc.v3i1.13869 ◽

2013 ◽

Vol 3 (1) ◽

pp. 18-23

Author(s):

Shamsul Alam ◽

ATM Mosharef Hossain ◽

AN Wakil Uddin ◽

Tariqul Islam ◽

Rezaul Amin ◽

...

Keyword(s):

Pituitary Adenoma ◽

Diabetes Insipidus ◽

Pituitary Adenomas ◽

Pituitary Surgery ◽

Electrolyte Imbalance ◽

Csf Leak ◽

Endoscopic Endonasal ◽

Microscopic Surgery ◽

Subtotal Removal

Background: The use of endoscope for the management of pituitary adenoma is not new. The better magnification and illumination provided by the endoscope gives better outcome than microscopic pituitary surgery. Objective: To find out the benefits of endoscope in relation to microscopic surgery. Materials and Methods: We performed 45 cases of pituitary adenoma surgery by endoscopic endonasal approach from July 2008 to July 2010. Results: Forty five cases underwent endoscopic transsphenoidal approach. Gross total removal was done in 35 cases and subtotal removal was done in 10 cases. Residual tumours were seen in 10 cases (22%) in postoperative follow-up MRI scan. Visual improvement was satisfactory, and hormonal improvement of functional adenoma was nice. Postoperative visual acuity and visual field were improved in 75% cases. There were 37% cases of temporary diabetes insipidus and about 4.5% cases of permanent diabetes insipidus. The average duration of follow-up was 20 months. One patient required reexploration to correct visual deterioration in the immediate postoperative period. There were 4.5% cases of CSF leak and 6.6% mortality. Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. Conclusion: Endoscopic endonasal pituitary surgery now has become a gold standard surgery for most of the pituitary adenomas because of its better advantages in relation to microscopic surgery and less complications and less hospital stay. DOI: http://dx.doi.org/10.3329/jemc.v3i1.13869 J Enam Med Col 2013; 3(1): 18-23

Download Full-text

STA-MCA Bypass as a “Bridge” to Pituitary Surgery in a Patient with an Adenoma Occluding the Internal Carotid Artery: Case Report and Review of the Literature

Case Reports in Neurological Medicine ◽

10.1155/2015/359586 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Luigi A. Lanterna ◽

Carlo Brembilla ◽

Antonio Signorelli ◽

Paolo Gritti ◽

Emanuele Costi ◽

...

Keyword(s):

Pituitary Adenoma ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Pituitary Surgery ◽

Minor Stroke ◽

Giant Pituitary Adenoma ◽

The Right

Occlusion of the intracranial internal carotid artery (ICA) by a pituitary adenoma with resulting cerebral ischemia is a very rare but devastating occurrence. The authors present a case in which a condition of symptomatic ICA occlusion due to a giant pituitary adenoma was successfully treated using a preliminary extraintracranial bypass as a “bridge” to the tumor removal. A 52-year-old patient presented with a minor stroke followed by pressure-dependent transient ischemic attacks consistent with a condition of hypoperfusion. MR imaging and a digital subtraction angiography revealed a pituitary adenoma occluding the ICA on the right side. He underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass with the aim of revascularizing the ischemic hemisphere and reducing the risk of perioperative stroke or stroke evolution. The patient was subsequently operated on to remove the adenoma through a transsphenoidal approach. The postoperative course was uneventful and the patient has suffered no further ischemic events. When there are no emergency indications to decompress the optical pathways but the patient is at risk of impending stroke because of ICA occlusion, a two-step strategy consisting of a bypass and subsequent removal of the pituitary adenoma may be a valuable option.

Download Full-text

A critical evaluation of transsphenoidal pituitary surgery in the treatment of Cushing's disease: Prediction of outcome

Acta Endocrinologica ◽

10.1530/acta.0.1230423 ◽

1990 ◽

Vol 123 (4) ◽

pp. 423-430 ◽

Cited By ~ 50

Author(s):

Richard D Arnott ◽

Richard G Pestell ◽

Penelope A McKelvie ◽

J Keith Henderson ◽

Peter M McNeill ◽

...

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Critical Evaluation ◽

Pituitary Surgery ◽

Urinary Free Cortisol ◽

Cushing's Disease ◽

Late Relapse ◽

Free Cortisol ◽

Transsphenoidal Pituitary Surgery ◽

Cortisol Excretion

Abstract. Twenty-eight patients underwent transsphenoidal pituitary surgery for Cushing's disease. Selective surgical procedures were performed in 26. In 19 patients pituitary adenoma was confirmed histologically and 5 had clumps or clusters of ACTH-staining cells. At follow-up after 22.3 (range 5-56) months 21 (75%) patients remained in clinical and biochemical remission. The 24-h urinary free cortisol performed between 1 and 4 weeks postoperatively while patients took replacement doses of dexamethasone (0.5 to 0.75 mg per day) was found to predict outcome. All patients with suppressed urinary free cortisol excretion have remained in remission, 3 with levels in the normal range have suffered late relapse after initial remission, and 4 with elevated urinary free cortisol excretion were regarded as having failed to remit. Furthermore, all patients with unsuccessful outcomes had no pituitary adenoma and 3 had features consistent with corticotrope nodular hyperplasia at histological examination compared to only 2 and 1, respectively, of patients still in remission. We conclude that 24-h urinary free cortisol performed at 1 to 4 weeks postoperatively whilst on low-dose dexamethasone and the histological findings may predict outcome following transsphenoidal pituitary surgery in Cushing's disease.

Download Full-text