Effect of transsphenoidal surgery on pituitary function

2015 ◽  
Author(s):  
M. Ohta ◽  
T. Uozumi ◽  
K. Sakoda ◽  
M. Gen ◽  
S. Shinohara ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Pituitary Function

scholarly journals Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas

2019 ◽  
Vol 131 (4) ◽  
pp. 1142-1151 ◽  
Author(s):  
Maya Harary ◽  
Aislyn C. DiRisio ◽  
Hassan Y. Dawood ◽  
John Kim ◽  
Nayan Lamba ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Tumor Size ◽  
Transsphenoidal Surgery ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Pituitary Hormone ◽  
Tumor Diameter ◽  
Endoscopic Transsphenoidal Surgery ◽  
Gland Volume ◽  
The Relationship

OBJECTIVELoss of pituitary function due to nonfunctional pituitary adenoma (NFPA) may be due to compression of the pituitary gland. It has been proposed that the size of the gland and relative perioperative gland expansion may relate to recovery of pituitary function, but the extent of this is unclear. This study aims to assess temporal changes in hormonal function after transsphenoidal resection of NFPA and the relationship between gland reexpansion and endocrine recovery.METHODSPatients who underwent endoscopic transsphenoidal surgery by a single surgeon for resection of a nonfunctional macroadenoma were selected for inclusion. Patients with prior pituitary surgery or radiosurgery were excluded. Patient characteristics and endocrine function were extracted by chart review. Volumetric segmentation of the pre- and postoperative (≥ 6 months) pituitary gland was performed using preoperative and long-term postoperative MR images. The relationship between endocrine function over time and clinical attributes, including gland volume, were examined.RESULTSOne hundred sixty eligible patients were identified, of whom 47.5% were female; 56.9% of patients had anterior pituitary hormone deficits preoperatively. The median tumor diameter and gland volume preoperatively were 22.5 mm (interquartile range [IQR] 18.0–28.8 mm) and 0.18 cm3 (IQR 0.13–0.28 cm3), respectively. In 55% of patients, endocrine function normalized or improved in their affected axes by median last clinical follow-up of 24.4 months (IQR 3.2–51.2 months). Older age, male sex, and larger tumor size were associated with likelihood of endocrine recovery. Median time to recovery of any axis was 12.2 months (IQR 2.5–23.9 months); hypothyroidism was the slowest axis to recover. Although the gland significantly reexpanded from preoperatively (0.18 cm3, IQR 0.13–0.28 cm3) to postoperatively (0.33 cm3, IQR 0.23–0.48 cm3; p < 0.001), there was no consistent association with improved endocrine function.CONCLUSIONSRecovery of endocrine function can occur several months and even years after surgery, with more than 50% of patients showing improved or normalized function. Tumor size, and not gland volume, was associated with preserved or recovered endocrine function.

scholarly journals Transsphenoidal Surgery for Cushing's Disease

1986 ◽  
Vol 79 (5) ◽  
pp. 262-269 ◽  
Author(s):  
R Fahlbusch ◽  
M Buchfelder ◽  
O A Müller
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Dynamic Testing ◽  
Remission Rate ◽  
Cushing's Syndrome ◽  
Bilateral Adrenalectomy ◽  
Pituitary Function ◽  
Cushing's Disease ◽  
Mortality And Morbidity

A series of 101 patients with Cushing's disease underwent transsphenoidal surgery. Diagnosis was fundamentally based on dynamic testing, mainly on the dosage-dependent suppression of cortisol after dexamethasone. The effect of surgery was monitored by intraoperative ACTH measurements. In 96 out of 101 patients a microadenoma of the pituitary was identified and removed selectively. In 74% of patients there was a clinical and endocrinological remission of Cushing's disease. Four ‘operative failures’ after selective adenomectomy underwent hypophysectomy in a second operation and each remitted. Thus the overall remission rate was 77%. In general, bilateral adrenalectomy was performed in patients who had failed to remit after selective adenomectomy. Although there is a considerable mortality and morbidity in patients with Cushing's syndrome, complications attributed to surgery were low. Two patients died postoperatively. In general, an improvement of disturbed pituitary function was noted after selective adenomectomy.

Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas

1984 ◽  
Vol 61 (3) ◽  
pp. 577-580 ◽  
Author(s):  
Alfred T. Nelson ◽  
H. St. George Tucker ◽  
Donald P. Becker
Keyword(s):  
Anterior Pituitary ◽  
Transsphenoidal Surgery ◽  
Normal Function ◽  
Pituitary Function ◽  
Acceptable Risk ◽  
Content Type ◽  
Anterior Pituitary Function ◽  
Improved Function ◽  
Pituitary Macroadenomas ◽  
Transsphenoidal Resection

✓ A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.

Optimal Surgical Approaches for Rathke Cleft Cyst With Consideration of Endocrine Function

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. ons250-ons258 ◽  
Author(s):  
Jeong Kyung Park ◽  
Eun Jig Lee ◽  
Sun Ho Kim
Keyword(s):  
Visual Field ◽  
Transsphenoidal Surgery ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Female Ratio ◽  
Rathke Cleft Cyst ◽  
Function Test ◽  
The Mean ◽  
Pituitary Function Test

ABSTRACT BACKGROUND: Surgical indications for Rathke cleft cyst are not clear. OBJECTIVE: To evaluate postoperative outcomes in terms of endocrine function. METHODS: The study analyzed a total 73 patients who underwent transsphenoidal surgery. All patients underwent a visual field test, combined pituitary function test, and magnetic resonance imaging before and after surgery. A follow-up combined pituitary function test was performed at 1.5-year intervals. RESULTS: The mean age at the time of surgery was 35 ± 14 years, and the male/female ratio was 1:1.25 (33/40). The mean follow-up duration after surgery was 59 ± 39 months. The most common symptoms were headache (84%), visual disturbance (48%), and polyuria (38%). After transsphenoidal surgery, 75% of polyuria and 96% of visual field defects were resolved, and pituitary function improved in 42% of patients. The mean age of patients who exhibited worsened hypopituitarism was significantly higher than that of patients who exhibited unchanged or improved hypopituitarism (44 ± 15.7 vs 33 ± 13.5 years; P = .02). Twelve patients (16%) experienced recollection of cyst, but none required reoperation. Five of the recollected cysts presented with characteristics that were different from those of the initial lesions, and 2 recollected cysts underwent spontaneous regression. CONCLUSION: Minimal incision with radical removal of cyst content is reasonable to prevent the development of endocrine disturbances and other complications. Individualized risks and benefits must be assessed before a decision is reached regarding surgery and surgical method. Patients with recurrent Rathke cleft cyst require careful follow-up with special attention rather than a hasty operation.

A Benchmark for Preservation of Normal Pituitary Function After Endoscopic Transsphenoidal Surgery for Pituitary Macroadenomas

2016 ◽  
Vol 91 ◽  
pp. 371-375 ◽  
Author(s):  
Edward R. Laws ◽  
Sherry L. Iuliano ◽  
David J. Cote ◽  
Whitney Woodmansee ◽  
Liangge Hsu ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Pituitary Function ◽  
Endoscopic Transsphenoidal Surgery ◽  
Pituitary Macroadenomas

scholarly journals Pituitary function after transsphenoidal surgery including measurement of basal morning cortisol as predictor of adrenal insufficiency

2021 ◽  
Author(s):  
Ida Staby ◽  
Jesper Krogh ◽  
Marianne Klose ◽  
Jonas Baekdal ◽  
Ulla Feldt-Rasmussen ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Predictive Value ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Tumour Size ◽  
Endocrine Function ◽  
Pituitary Function ◽  
Adrenal Axis ◽  
Post Surgery ◽  
Basal Cortisol

Introduction: Patients with pituitary adenomas undergoing transsphenoidal surgery require pre- and post-surgery examination of pituitary hormones. There is currently no consensus on how to evaluate the adrenal axis post-surgery. The aims of this study were to investigate factors that may predict postoperative adrenal insufficiency (AI) and to investigate the overall effect of transsphenoidal surgery on the pituitary function. Methods: One-hundred-and-forty-three consecutive patients who had undergone transsphenoidal surgery for pituitary adenomas were included. Data on tumour size, pituitary function pre-surgery, plasma basal cortisol measured within 48 hours post-surgery and pituitary function 6 months post-surgery were collected. Patients with AI prior to surgery, perioperative glucocorticoid treatment, Cushing’s disease and no re-evaluation after 1 month were excluded (n=93) in the basal cortisol analysis. Results: Low plasma basal cortisol post-surgery, tumour size and previous pituitary surgery were predictors of AI (all p<0.05). A basal cortisol cut-off concentration of 300 nmol/L predicted AI 6 months post-surgery with a sensitivity and negative predictive value of 100%, specificity of 81% and positive predictive value of 25%. New gonadal, thyroid and adrenal axis insufficiencies accounted for 2%, 10% and 10%, respectively. The corresponding recovery rates were 17%, 7% and 24%, respectively Conclusion: Transsphenoidal surgery had an overall beneficial effect on pituitary endocrine function. Low basal plasma cortisol measured within 48 hours after surgery, tumour size and previous surgery were identified as risk factors for AI. Measurement of basal cortisol post-surgery may help identifying patients at risk of developing AI.

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