Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: A study on 184 patients

Abstract

Residual tumour after surgery was detected in 37.1% of patients with nonfunctioning adenomas. The remission rates for patients with functioning adenomas, as documented by the last endocrinological evaluation, were 54.9% for growth hormone-secreting, 69.5% for adrenocorticotropin hormone-secreting, 72.7% for prolactin-secreting and 100% for thyroid-stimulating hormone-secreting, with two recurrences in patients with cushing's disease. Multivariate analysis showed that factors influencing surgical outcome were cavernous sinus invasion, large tumour diameter (≥25 mm) and reoperation for the nonfunctioning adenomas, and cavernous sinus invasion as well as large tumour diameter (≥25 mm) for the functioning adenomas. In the latter cohort, predictors for endocrinological remission were maximum tumour diameter (≤20 mm) and reoperation. Postoperative complications were present in 3.3% of the cases. One patient developed epistaxis, two hemorrhage at the surgical field, one postoperative rhinorrhea, one postoperative permanent diabetes insipidus and one postoperative panhypopituitarism. cONcLUsIONs: Microsurgical transsphenoidal surgery is an effective and safe treatment in all patients with pituitary adenomas, except for prolactinomas responsive to medical therapy.

A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

“…For patients with pituitary adenomas, compression of the hypophyseal portal system and hypophyseal stalk together with partial avascular necrosis of the adenohypophysis are considered to be the main mechanisms of hypopituitarism [ 30 , 32 , 33 ]. Microsurgical transsphenoidal surgery is shown to be safe and efficacious for pituitary adenoma resection in all patients except for those with prolactinomas that are responsive to medical therapy [ 34 ]. Pituitary surgery may improve the pituitary function of patients with hypopituitarism caused by pituitary adenoma, and pituitary function can be restored in nearly half of patients after surgery [ 35 ].…”

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

“…The term ‘remission’ is defined by hypocortisolism with low serum cortisol (<5 μg/dL) and/or low urinary free cortisol (<20 mg per 24 h), and/or low cortisol (<1.8 mg/dL) level after 1 mg dexamethasone. Most of the studies also defined eucortisolism as remission ( 15 , 17 , 18 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 ). Several studies also include the need for corticosteroid replacement and significant changes in clinical features as remission criteria ( 14 , 25 , 30 , 34 , 35 ).…”

Prediction of therapy response in acromegalic patients under pegvisomant therapy within the German ACROSTUDY cohort

“…Factors that are related to therapy response after surgery, radiotherapy and somatostatin analogue therapy include biological characteristics of the tumor (such as sst receptor and gene expression), duration of the disease, GH levels at baseline and basic socioeconomic factors such as age, gender and BMI [8][9][10][11][12][13][14]. However nowadays, in addition to clinical variables, subjective health measures are widely assessed within clinical research settings in order to guide patient-oriented decisions.…”