scholarly journals Role of Pituitary Stalk and Gland Radiological Status on Endocrine Function and Outcomes after Endoscopic Transsphenoidal Surgery for Non-functioning Pituitary Adenomas

2021 ◽  
Author(s):  
Catalina Vivancos Sánchez ◽  
Alexis Palpán Flores ◽  
Víctor Rodríguez Domínguez ◽  
Álvaro Zamarrón Pérez ◽  
Cristina Álvarez-Escolá ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Tumour Volume ◽  
Endocrine Function ◽  
Pituitary Stalk ◽  
Endoscopic Transsphenoidal Surgery ◽  
Improvement Rate ◽  
Hormonal Function ◽  
Younger Age

Abstract PurposeTo investigate endocrine function changes after nonfunctioning pituitary adenomas (NFPA) transsphenoidal surgery and to search for predictors of hypopituitarism resolution and development.MethodsWe included 117 patients with NFPA who underwent endoscopic transsphenoidal surgery from 2005 to 2019 by two neurosurgeons. 21 patients were excluded because of previous pituitary surgery or radiotherapy. We assessed symptoms at diagnosis, tumour volume, tumour removal, hormonal status at diagnosis, hormonal outcomes at 2- and 12-months follow-up, and complications. Pituitary stalk and gland MRI status (visible or not) were included, and its association to hormonal function was studied for the first time, to our knowledge.ResultsPituitary gland visualization was more frequent in those patients who showed a smaller number of axes affected at 12 months (p=0.011). Pituitary stalk status showed no association to hormonal function. Hormonal normalization rate at 12 months was 13%. Endocrine improvement rate at 12 months was 16.7%. Worsening of hormonal function occurred in 19.8% of patients. Younger age was associated to hormonal improvement (p=0.004). Higher preoperative tumour volume and absence of gross total resection (GTR) (p=0.049) were associated with worsening in at least one hormonal axis after surgery (p=0.015).Conclusionituitary gland visibility was higher in those patients who showed better hormonal outcomes. Assessment of initial hormonal function and outcome after surgery regarding pituitary stalk status showed no significant association. Higher preoperative tumor volumes and absence of GTR were associated to postoperative endocrine function worsening, while younger age was associated to its improvement.

scholarly journals Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

2016 ◽  
Vol 124 (6) ◽  
pp. 1627-1633 ◽  
Author(s):  
Amparo Wolf ◽  
Sandy Goncalves ◽  
Fateme Salehi ◽  
Jeff Bird ◽  
Paul Cooper ◽  
...  
Keyword(s):  
Mental Health ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Short Form ◽  
Significant Proportion ◽  
Endoscopic Transsphenoidal Surgery ◽  
Headache Severity ◽  
Younger Age ◽  
Sf 36 ◽  
The Impact

OBJECT The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). METHODS In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. CONCLUSIONS The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

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.

Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis

2016 ◽  
Vol 124 (3) ◽  
pp. 589-595 ◽  
Author(s):  
Arman Jahangiri ◽  
Jeffrey R. Wagner ◽  
Sung Won Han ◽  
Mai T. Tran ◽  
Liane M. Miller ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Time Course ◽  
Hormone Replacement ◽  
Endocrine Function ◽  
Gland Volume ◽  
Younger Age ◽  
Thyroid Axis ◽  
Nonfunctional Pituitary Adenomas ◽  
The Impact

OBJECT The impact of transsphenoidal surgery for nonfunctional pituitary adenomas (NFAs) on preoperative hypopituitarism relative to the incidence of new postoperative endocrine deficits remains unclear. The authors investigated rates of hypopituitarism resolution and development after transsphenoidal surgery. METHODS Over a 5-year period, 305 transsphenoidal surgeries for NFAs performed at The California Center for Pituitary Disorders were retrospectively reviewed. RESULTS Patients with preoperative endocrine deficits (n = 153, 50%) were significantly older (mean age 60 vs 54 years; p = 0.004), more frequently male (65% vs 44%; p = 0.0005), and had larger adenomas (2.4 cm vs 2.1 cm; p = 0.02) than patients without preoperative deficits (n = 152, 50%). Of patients with preoperative endocrine deficits, 53% exhibited symptoms. Preoperative deficit rates were 26% for the thyroid axis; 20% and 16% for the male and female reproductive axes, respectively; 13% for the adrenocorticotropic hormone (ACTH)/cortisol axis, and 19% for the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis. Laboratory normalization rates 6 weeks and 6 months after surgery without hormone replacement were 26% and 36% for male and 13% and 13% for female reproductive axes, respectively; 30% and 49% for the thyroid axis; 3% and 3% for the cortisol axis; and 9% and 22% for the IGF-1 axis (p < 0.05). New postoperative endocrine deficits occurred in 42 patients (13.7%). Rates of new deficits by axes were: male reproductive 3% (n = 9), female reproductive 1% (n = 4), thyroid axis 3% (n = 10), cortisol axis 6% (n = 19), and GH/IGF-1 axis 4% (n = 12). Patients who failed to exhibit any endocrine normalization had lower preoperative gland volumes than those who did not (0.24 cm3 vs 0.43 cm3, respectively; p < 0.05). Multivariate analyses revealed that no variables predicted new postoperative deficits or normalization of the female reproductive, cortisol, and IGF-1 axes. However, increased preoperative gland volume and younger age predicted the chances of a patient with any preoperative deficit experiencing normalization of at least 1 axis. Younger age and less severe preoperative hormonal deficit predicted normalization of the thyroid and male reproductive axes (p < 0.05). CONCLUSIONS After NFA resection, endocrine normalization rates in this study varied with the hormonal axis and were greater than the incidence of new endocrine deficits. Low preoperative gland volume precluded recovery. Patient age and the severity of the deficiency influenced the recovery of the thyroid and male reproductive axes, the most commonly impaired axes and most likely to normalize postoperatively. This information can be of use in counseling patients with hypopituitarism who undergo NFA surgery.

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.

Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center

2010 ◽  
Vol 29 (4) ◽  
pp. E7 ◽  
Author(s):  
Jackson A. Gondim ◽  
João Paulo Almeida ◽  
Lucas Alverne F. de Albuquerque ◽  
Erika Gomes ◽  
Michele Schops ◽  
...  
Keyword(s):  
Growth Factor ◽  
Disease Control ◽  
Endoscopic Surgery ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Insulin Like Growth Factor ◽  
Endoscopic Transsphenoidal Surgery ◽  
Factor I ◽  
Transsphenoidal Endoscopic Surgery ◽  
Growth Factor I

Object Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. Methods The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex. Results During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Conclusions Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.

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.

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