scholarly journals Predictive factors for delayed hyponatremia after transsphenoidal surgery in patients with pituitary adenomas

2021 ◽  
Author(s):  
Kunzhe Lin ◽  
Lingling Lu ◽  
Zhijie Pei ◽  
Shuwen Mu ◽  
Shaokuan Huang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Odds Ratio ◽  
Transsphenoidal Surgery ◽  
Post Surgery ◽  
Factors Influencing ◽  
Significant Difference ◽  
Pituitary Thyroid Axis ◽  
Thyroid Axis

Objective: To evaluate the incidence and duration of delayed hyponatremia and to assess the factors influencing the development of delayed hyponatremia after transsphenoidal surgery (TSS) in pituitary adenomas. Methods: We retrospectively analyzed the clinical data of patients with pituitary adenoma who underwent TSS. Univariable and multivariable statistics were carried out to identify factors independently associated with the occurrence of delayed hyponatremia. Results: Of the 285 patients with pituitary adenoma who underwent microscopic TSS, 44 (15.4%) developed postoperative delayed hyponatremia and 241 (84.6%) did not. The onset of delayed hyponatremia occurred an average of 5.84 days post-surgery and persisted for an average of 5.36 days. Logistic regression analysis showed the highest risk of delayed hyponatremia in patients with significant change in tumor cavity height (odds ratio [OR], 1.158; 95% confidence interval [CI], 1.062, 1.262; P = 0.001), preoperative hypothalamus-pituitary-thyroid axis hypofunction(OR, 3.112; 95% CI, 1.481, 6.539; P = 0.003), and significant difference in blood sodium levels before and 2 days after TSS(OR, 1.101; 95% CI, 1.005, 1.206; P = 0.039). Conclusions: Preoperative hypothyroidism, difference in blood sodium levels before and 2 days after TSS, and the change in tumor cavity height after TSS played important roles in predicting postoperative delayed hyponatremia onset in patients with pituitary adenomas.

scholarly journals A retrospective analysis of postoperative hypokalemia in pituitary adenomas after transsphenoidal surgery

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3337 ◽  
Author(s):  
Lili You ◽  
Wenpeng Li ◽  
Tang Chen ◽  
Dongfang Tang ◽  
Jinliang You ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Pituitary Adenoma ◽  
Logistic Regression Analysis ◽  
Serum Potassium ◽  
Repeated Measures ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Multiple Logistic Regression Analysis ◽  
Endoscopic Endonasal

Background Pituitary adenoma is one of the most common intracranial neoplasms, and its primary treatment is endoscopic endonasal transsphenoidal tumorectomy. Postoperative hypokalemia in these patients is a common complication, and is associated with morbidity and mortality. This study aimed to analyze the etiopathology of postoperative hypokalemia in pituitary adenomas after endoscopic transsphenoidal surgery. Methods and Materials This retrospective study included 181 pituitary adenomas confirmed by histopathology. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Repeated measures ANOVA was used to analyze change in serum potassium levels at different time points. Results Multiple Logistic regression analysis revealed that only ACTH-pituitary adenoma (OR = 4.92, 95% CI [1.18–20.48], P = 0.029) had a significant association with postoperative hypokalemia. Moreover, the overall mean serum potassium concentration was significantly lower in the ACTH versus the non-ACTH group (3.34 mmol/L vs. 3.79 mmol/L, P = 0.001). Postoperative hypokalemia was predominantly found in patients with ACTH-pituitary adenoma (P = 0.033). Conclusions ACTH-pituitary adenomas may be an independent factor related postoperative hypokalemia in patients despite conventional potassium supplementation in the immediate postoperative period.

Transsphenoidal Endoscopic versus Microscopic Approach in Treatment of Pituitary Adenomas: CSF Leak and GTR Systematic review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim M Omran ◽  
Hamdy Ibrahim ◽  
Emad Maamon ◽  
Ahmed Yousry
Keyword(s):  
Brain Tumors ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Endoscopic Transsphenoidal Surgery ◽  
Microscopic Surgery ◽  
Cochrane Database ◽  
Number Of Patients ◽  
Significant Difference ◽  
Endoscopic Group

Abstract Background Pituitary adenomas (PAs) are the second most common brain tumors, 10% to 20% of all primary brain tumors. Transsphenoidal approach is now the gold standard for treatment of PAs either microscopic or endoscopic. Aim of the Work to analyze the collective outcomes from studies comparing the microscopic transsphenoidal surgery (MTS) with the endoscopic transsphenoidal surgery (ETS) regarding gross total resection (GTR) and postoperative cerebrospinal fluid (CSF) leak. Patients and Methods we searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following keywords “Pituitary adenoma/tumor, endoscopy or endoscopic, microscopy or microscopic, gross total/subtotal/near total/radicular resection/excision, hypophysectomy, debulking, CSF leak/leakage ". The mentioned databases were searched for studies published during period from the 1st of Jan 2015 to 31 Aug. 2020. Results Total number of patients in included studies was 1211 of which 621 (51.3%) underwent endoscopic surgery and 590 (48.7%) underwent microscopic surgery. Of 990 patient analysed for GTR, it was achieved in 334 patients (69.4%) in endoscopic group compared with 287 patients (56.4%) in microscopic group. Of 1211 patients, Postoperative CSF leak developed in 30 patients (5.7%) compared with 32 patients (4.7%) in endoscopic and microscopic group respectively. Conclusion GTR was found to be slightly higher in the endoscopic group especially in cases of suprasellar and lateral cavernous extensions. CSF leak showed no significant difference between the two groups.

Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis

2017 ◽  
Vol 156 (3) ◽  
pp. 484-488 ◽  
Author(s):  
Erdem Eren ◽  
Toygar Kalkan ◽  
Seçil Arslanoğlu ◽  
Mustafa Özmen ◽  
Kazım Önal ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Nasal Mucosa ◽  
Odds Ratio ◽  
Granulomatosis With Polyangiitis ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Significant Difference ◽  
History Of

Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient’s diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea ( P = .002), postnasal drip ( P = .015), epistaxis ( P < .001), and saddle nose ( P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis ( P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion ( P = .028), nasal septal perforation ( P < .017), nasal crusting ( P < .001), nasal adhesion ( P < .001), nasal granuloma ( P = .017), and hemorrhagic fragile nasal mucosa ( P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa ( P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.

scholarly journals Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly

2020 ◽  
Vol 48 (6) ◽  
pp. E10 ◽  
Author(s):  
Tyler Cardinal ◽  
Martin J. Rutkowski ◽  
Alexander Micko ◽  
Mark Shiroishi ◽  
Chia-Shang Jason Liu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Medical Therapy ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cranial Nerves ◽  
Elevated Serum ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Csf Leakage

OBJECTIVEAcromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor–1 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.METHODSThe authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.RESULTSThe 52 patients had a mean age of 50.7 ± 13.4 years and a mean follow-up duration of 24.4 ± 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.CONCLUSIONSEndoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.

scholarly journals NCOG-53. PREDICTORS OF ENDOCRINE OUTCOME AFTER ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR NON-FUNCTIONING PITUITARY ADENOMAS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii141-ii141
Author(s):  
Jenie Hwang ◽  
Diane Yum ◽  
Michael Chicoine ◽  
Ralph Dacey ◽  
Joshua Osbun ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
De Novo ◽  
Postoperative Recovery ◽  
Endocrine Function ◽  
Male Hypogonadism ◽  
Endoscopic Transsphenoidal Surgery ◽  
Thyroid Axis ◽  
Negative Predictor ◽  
New Onset

Abstract BACKGROUND Although endoscopic transsphenoidal surgery (ETSS) is an established treatment for patients with nonfunctioning pituitary adenomas (NFPAs), data are limited regarding the rates and predictors of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS. OBJECTIVE To analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. METHODS Among a cohort of 601 consecutive patients who underwent ETSS for NFPA between 2010 and 2018 at Washington University in Saint Louis, recovery or development of new hypopituitarism was retrospectively analyzed in 209 patients. RESULTS Preoperative endocrine deficits were observed in 59.8% of patients (125/209), and the deficit rates were 76.8% for male gonadal axis (86/112), 42.5% for thyroid axis, 25.8% for growth hormone axis, and 15.8% for cortisol axis. Recovery of preoperative pituitary deficit was noted in all four axes, with highest recovery in the cortisol axis with a 1-year cumulative recovery rate of 44.3%. New-onset postoperative hypopituitarism occurred most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Multivariate analyses revealed axis-specific predictors of postoperative recovery and de novo deficiency. Older age was a negative predictor for recovery of both male hypogonadism (P= 0.04) and adrenal insufficiency (P=0.046), and a larger tumor volume was a negative predictor for recovery of hypothyroidism (P=0.043). Although higher body mass index was generally associated with any new postoperative pituitary deficit (P=0.03), most predictors of new onset deficits also differed by hormone axis. CONCLUSIONS Dynamic changes in pituitary hormonal levels were observed in a significant fraction of patients following ETSS in NFPA patients. The specific hormonal axis dictated postoperative endocrine vulnerability, recovery, and predictors of recovery or loss of endocrine function.

scholarly journals Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study

2019 ◽  
Vol 47 (2) ◽  
pp. E5 ◽  
Author(s):  
Kang Guo ◽  
Lijun Heng ◽  
Haihong Zhang ◽  
Lei Ma ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Bubble Diameter ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Cns Infections ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Intracranial Infections

OBJECTIVEThe authors sought to identify the relevance between pneumocephalus and postoperative intracranial infections, as well as bacteriological characteristics and risk factors for intracranial infections, in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery.METHODSIn total, data from 251 consecutive patients with pituitary adenomas who underwent pure endoscopic endonasal transsphenoidal surgeries from 2014 to 2018 were reviewed for preoperative comorbidities, intraoperative techniques, and postoperative care.RESULTSThis retrospective study found 18 cases of postoperative pneumocephalus (7.17%), 9 CNS infections (3.59%), and 12 CSF leaks (4.78%). Of the patients with pneumocephalus, 5 (27.8%) had CNS infections. In patients with CNS infections, the culture results were positive in 7 cases and negative in 2 cases. The statistical analysis suggested that pneumocephalus (maximum bubble diameter of ≥ 1 cm), diaphragmatic defects (intraoperative CSF leak, Kelly grade ≥ 1), and a postoperative CSF leak are risk factors for postoperative CNS infections.CONCLUSIONSIn pituitary adenoma patients who underwent pure endoscopic endonasal transsphenoidal surgeries, intraoperative saddle reconstruction has a crucial role for patients with postoperative intracranial infections. Additionally, postoperative pneumocephalus plays an important role in predicting intracranial infections that must not be neglected. Therefore, neurosurgeons should pay close attention to the discovery of postoperative intracranial pneumocephalus because this factor is as important as a postoperative CSF leak. Pneumocephalus (maximum bubble diameter of ≥ 1 cm), diaphragmatic defects (an intraoperative CSF leak, Kelly grade ≥ 1), and a postoperative CSF leak were risk factors predictive of postoperative intracranial infections. In addition, it is essential that operative procedures be carefully performed to avoid diaphragmatic defects, to reduce exposure to the external environment, and to decrease patients’ suffering.

Risk factors for development of obesity in an ethnically diverse CHD population

2019 ◽  
Vol 29 (2) ◽  
pp. 123-127
Author(s):  
Scott J. Weinreb ◽  
Abigail J. Pianelli ◽  
Sreyans R. Tanga ◽  
Ira A. Parness ◽  
Rajesh U. Shenoy
Keyword(s):  
Body Mass Index ◽  
Regression Analysis ◽  
Linear Regression ◽  
Longitudinal Data ◽  
Body Mass ◽  
Linear Regression Analysis ◽  
Paediatric Population ◽  
Post Surgery ◽  
Significant Difference ◽  
Age Cohort

AbstractObjectivesPrevious cross-sectional studies have demonstrated obesity rates in children with CHD and the general paediatric population. We reviewed longitudinal data to identify factors predisposing to the development of obesity in children, hypothesising that age may be an important risk factor for body mass index growth.Study designRetrospective electronic health records were reviewed in all 5–20-year-old CHD patients seen between 2011 and 2015, and in age-, sex-, and race/ethnicity-matched controls. Subjects were stratified into aged cohorts of 5–10, 11–15, and 15–20. Annualised change in body mass index percentile (BMI%) over this period was compared using paired Student’s t-test. Linear regression analysis was performed with the CHD population.ResultsA total of 223 CHD and 223 matched controls met the inclusion criteria for analysis. Prevalence of combined overweight/obesity did not differ significantly between the CHD cohort (24.6–25.8%) and matched controls (23.3–29.1%). Univariate analysis demonstrated a significant difference of BMI% change in the age cohort of 5–10 (CHD +4.1%/year, control +1.7%/year, p=0.04), in male sex (CHD +1.8%/year, control −0.3%/year, p=0.01), and status-post surgery (CHD 2.03%/year versus control 0.37%, p=0.02). Linear regression analysis within the CHD subgroup demonstrated that age 5–10 years (+4.80%/year, p<0.001) and status-post surgery (+3.11%/year, p=0.013) were associated with increased BMI% growth.ConclusionsPrevalence rates of overweight/obesity did not differ between children with CHD and general paediatric population over a 5-year period. Longitudinal data suggest that CHD patients in the age cohort 5–10 and status-post surgery may be at increased risk of BMI% growth relative to peers with structurally normal hearts.

scholarly journals Prognostic impact and post-procedural development of severe tricuspid regurgitation in patients undergoing transcatheter edge-to-edge mitral valve repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Kavsur ◽  
C Iliadis ◽  
C Metze ◽  
M Spieker ◽  
V Tiyerili ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Odds Ratio ◽  
Survival Rates ◽  
Right Atrial ◽  
Prognostic Impact ◽  
Severe Tricuspid Regurgitation ◽  
Significant Difference

Abstract Purpose The aim of this study was to investigate the clinical impact and post-procedural development of tricuspid regurgitation (TR) in patients undergoing the MitraClip procedure for severe mitral regurgitation. Methods In this present multicentre study, we included 940 patients undergoing MitraClip implantation for symptomatic mitral regurgitation from August 2010 to September 2018. Patients were categorized according to concomitant TR (none or mild vs moderate vs severe) and the prognostic impact of TR on 1-year mortality was evaluated. Moreover, in 377 patients, we assessed 3-months echocardiographic controls to further analyse the post-procedural development of TR. Results At baseline, concomitant TR was graded none/mild in 393 (42%), moderate in 316 (34%), and severe in 231 (25%) patients. During 1-year follow-up, 141 of 940 (15%) patients died. According to mild/none, moderate and severe TR, mortality rates were 13%, 12%, and 23%, respectively, revealing a higher prevalence of death in patients with severe TR (p=0.001). Kaplan-Meier analysis and log-rank test confirmed inferior survival rates for patients with severe TR (p=0.001), while there were no significant difference in survival rates between patients with none/mild vs moderate TR (p=0.561). Regarding 1-year mortality, multivariate cox regression analysis, revealed an odds ratio of 1.739 (1.024–2.953; p=0.041), associated with severe TR. After 3-months follow-up, echocardiography in 377 patients showed following TR grade distributions: 44% none/mild, 37% moderate and 19% severe TR. In 100 patients (27%), TR improved by one or more grades, while 64 patients (17%) showed a TR worsening. In patients with severe TR at baseline, 42 of 91 (46%) patients showed a reduction in TR of one or more grades. Patients with severe TR at baseline, who showed a TR improvement during 3-months follow-up, had lower rates of 1-year mortality (p=0.025). For these patients, in regression analysis, right atrial area was revealed as only predictor of TR improvement after MitraClip procedure [odds ratio 0.958 (0.918–0.999); p=0.046]. Conclusion One-fourth of patients undergoing MitraClip procedure for mitral regurgitation had concomitant severe tricuspid regurgitation which was predictive for worse prognosis. Post-procedural TR improvement of one or more grades was frequent in these patients and was associated with higher survival-rates. Funding Acknowledgement Type of funding source: None

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.

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.

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