Endocrine Outcomes After Pituitary Surgery

Buttan, Anshu; Mamelak, Adam N.

doi:10.1016/j.nec.2019.05.009

Cited by 14 publications

(18 citation statements)

References 72 publications

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“…In specialized referral centers, remission can be achieved in 80-90% of microadenomas and about 50% to 75% of macroadenomas, although these figures dramatically decrease when 12 the tumor is invasive or very large (e.g., >4 cm). (HQ) (43,44). Remission rates are likely lower at less experienced centers Surgical tumor debulking prior to medical therapy can be considered in appropriate candidates if the patient cannot be surgically cured (MQ), if a substantial amount of the mass can be successfully removed and/or there are symptoms of mass effect (45).…”

Section: Resultsmentioning

confidence: 99%

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Multidisciplinary management of acromegaly: A consensus

Giustina

Barkhoudarian

Beckers

et al. 2020

Rev Endocr Metab Disord

232

188

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The 13th Acromegaly Consensus Conference was held in November 2019 in Fort Lauderdale, Florida, and comprised acromegaly experts including endocrinologists and neurosurgeons who considered optimal approaches for multidisciplinary acromegaly management. Focused discussions reviewed techniques, results, and side effects of surgery, radiotherapy, and medical therapy, and how advances in technology and novel techniques have changed the way these modalities are used alone or in combination. Effects of treatment on patient outcomes were considered, along with strategies for optimizing and personalizing therapeutic approaches.Expert consensus recommendations emphasize how best to implement available treatment options as part of a multidisciplinary approach at Pituitary Tumor Centers of Excellence.

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Section: Resultsmentioning

confidence: 99%

“…Serum IGF-I levels to reliably define remission should be assessed at least 3 months postoperatively (HQ) (43,44). Early indication of remission may be obtained by measuring fasting GH on postoperative day 1 or 2, with lowest levels (<1 µg/L) having the best sensitivity to predict outcomes.…”

Section: Resultsmentioning

confidence: 99%

Multidisciplinary management of acromegaly: A consensus

Giustina

Barkhoudarian

Beckers

et al. 2020

Rev Endocr Metab Disord

232

188

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7] Postoperative endocrinopathies occur in 10 to 30% of patients who undergo pituitary adenoma surgery but vary depending on tumor type, tumor morphology, and specific hormonal axis (e.g., gonadotrophic, corticotrophic, thyrotropic, or somatotrophic). [8][9][10] Moreover, recovery of function can be seen in 5 to 50% of patients also depending on tumor characteristics and the hormonal axis. 9,11,12 The measurement of cortisol to predict adrenal insufficiency and postoperative administration remains controversial in the treatment of pituitary adenomas.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes of a Hydrocortisone Protocol after Endonasal Surgery for Pituitary Adenoma Resection

Alexander

Collopy

et al. 2021

J Neurol Surg B Skull Base

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Introduction In pituitary adenomas (PAs), the use of postoperative steroid supplementation remains controversial, as it reduces peritumoral edema and sinonasal complaints but disrupts the detection of adrenal insufficiency (AI). It is unclear whether postoperative cortisol supplementation has a measurable effect on improving outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery (ETS). The objective of the study was to evaluate a postoperative steroid treatment protocol on various surgical outcomes in patients with PA undergoing ETS. Methods A retrospective cohort study was performed for patients undergoing ETS from 2005 to 2020 for PA at a single tertiary academic center. Patients were divided into two groups: those managed by a routine postoperative glucocorticoid supplementation protocol (steroid protocol) and those who received supplementation based on postoperative cortisol laboratory assessment (steroid sparing protocol). Management was otherwise the same between groups. Evaluation of length of stay (LOS), sinonasal outcomes, 30-day readmission, and perioperative complications, including AI, were performed. Results Among 535 patients, 21% (n = 111) received postoperative steroids, while the remainder (n = 424) did not. There were no differences in mean LOS (3 vs. 3 days, p = 0.72), sinonasal complaints (27 vs. 19%, p = 0.12), 30-day readmission (5% vs. 5%, p = 0.44), and perioperative complications (5 vs. 5%, p = 0.79) between both the groups. A multivariate model supported that both groups were comparable in predicting LOS, 30-day readmission, and complications. No reduction in readmission for AI was seen. Conclusion Routine administration of postoperative glucocorticoids did not significantly improve patient outcomes in patients with PA who underwent ETS.

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“…GH-secreting pituitary adenomas are known to have high recurrence rates, averaging 10 to 20% in microadenomas and 25 to 50% in macroadenomas [10][11][12][13] ; these values appear to be fairly consistent across both endoscopic and microscopic approaches. 10,15 Reasons for the difficulty in achieving long-term remission in this patient population include extent of tumor resection, presence of dysmorphic features, and coexisting medical comorbidities.…”

Section: Discussionmentioning

confidence: 79%

Intraoperative Alcoholization of the Pituitary Gland Does Not Reduce the Recurrence Rate of Growth Hormone Secreting Pituitary Adenomas

Gill

Sumsion

Alt

et al. 2022

J Neurol Surg B Skull Base

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Objective Although the role of intraoperative alcoholization of the pituitary gland has been examined for the management of malignant tumor metastases and Rathke's cleft cysts, no such studies have been conducted relating to growth hormone (GH) secreting pituitary tumors, despite the high rate of recurrence in this cohort of patients. Here, we sought to understand the impact of adjunctive intraoperative alcoholization of the pituitary gland on recurrence rates and perioperative complications associated with resection of GH-secreting tumors. Methods This is a single-institution retrospective cohort study analyzing recurrence rates and complications among patients with GH-secreting tumors who received intraoperative alcoholization of the pituitary gland postresection versus those that did not. Welch's t-tests and analysis of variance (ANOVA) analyses were employed to compare continuous variables between groups, whereas chi-squared tests for independence or Fisher's exact tests were used for comparing categorical variables. Results A total of 42 patients (n = 22 no alcohol and n = 20 alcohol) were included in the final analysis. The overall recurrence rates did not significantly differ between the alcohol and no alcohol groups (35 and 22.7%, respectively; p = 0.59). The average time to recurrence in the alcohol and no alcohol groups was 22.9 and 39 months, respectively (p = 0.63), with a mean follow-up of 41.2 and 53.5 months (p = 0.34). Complications, including diabetes insipidus, were not significantly different between the alcohol and no alcohol groups (30.0 vs. 27.2%, p = 0.99). Conclusion Intraoperative alcoholization of the pituitary gland after resection of GH-secreting pituitary adenomas does not reduce recurrence rates or increase perioperative complications.

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Endocrine Outcomes After Pituitary Surgery

Cited by 14 publications

References 72 publications

Multidisciplinary management of acromegaly: A consensus

Multidisciplinary management of acromegaly: A consensus

Perioperative Outcomes of a Hydrocortisone Protocol after Endonasal Surgery for Pituitary Adenoma Resection

Intraoperative Alcoholization of the Pituitary Gland Does Not Reduce the Recurrence Rate of Growth Hormone Secreting Pituitary Adenomas

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