Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma

Abstract

Purpose Despite multidisciplinary care being commonly recommended, there remains limited evidence supporting its benefits in pituitary disease management. This study aimed to assess the impact of multidisciplinary care in pituitary surgery. Methods A retrospective cohort study was performed comparing pituitary surgery outcomes among consecutive patients within a quaternary referral center in 5 years before and after introduction of a multidisciplinary team (MDT). Primary outcomes were endocrine (transient diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH], and new hypopituitarism) and surgical (cerebrospinal fluid [CSF] leak, epistaxis, intracranial hemorrhage, and meningitis) complications, length of hospital stay, and intrasellar residual tumor. Results 279 patients (89 pre-MDT vs. 190 post-MDT) were assessed (age 54 ± 17 years, 48% female). Nonfunctioning adenomas were most common (54%). In the post-MDT era, more clinically functioning tumors (42 vs. 28%, p = 0.03) were treated. Transient DI and SIADH occurred less often post-MDT (20 vs. 36%, p < 0.01 and 18 vs. 39%, p < 0.01), as well as new hypothyroidism (5 vs. 15, p < 0.01). Hospital stay was shorter post-MDT (5[3] vs. 7[5] days, p < 0.001) and intrasellar residuals were less common (8 vs. 35%, p < 0.001). Complications were more frequent pre-MDT independent of tumor size, hormone status, and surgical technique (odds ratio [OR] = 2.14 [1.05–4.32], p = 0.04). Conclusion Outcomes of pituitary surgery improved after the introduction of an MDT. Pituitary MDTs may benefit both patients and the health system by improving quality of care and reducing hospital stays.

Transcription factor immunohistochemistry in the diagnosis of pituitary tumours

“…Application of transcription factor analysis has highlighted heterogeneity within the newly categorised Pit-1 positive plurihormonal tumours. We identified a spectrum of expression of hormone expression, ranging from absent to multiple (Table 3, patients 8,12,13,15,16,17,18,19). Other authors have proposed that Pit-1 positive plurihormonal tumours may be subdivided into 'poorly differentiated' and 'well-differentiated' (mature) variants, which would support our findings (16,23).…”

“…Tumour recurrence was defined as one or both of the following: a. Radiological recurrence, defined as regrowth of a remnant or new tumour growth, identified after gross total resection. This was evaluated based on radiology reports, clinical correspondence and/or MDT decision (18). b. Reintervention ≥12 months post-operatively.…”

Multidisciplinary Team Care in Pituitary Tumours

“…The pursuit of excellence in delivering the best care to patients with pituitary tumours and other sellar lesions, including craniopharyngiomas or Rathke’s cleft cysts, has led to the implementation of Pituitary MDT/PTCOE. Pituitary MDT/PTCOE are now widely recommended by different guidelines and medical societies relevant in the field [ 2 , 10 , 11 , 22 , 23 ]. The definition criteria of PTCOE have been proposed [ 10 ], and further validated in a survey of several internationally recognised tertiary centres [ 11 ].…”

“…Management of patients with pituitary diseases has much improved since the implementation of PTCOE, or Pituitary MDT, with a “patient-centric” philosophy where the patient is at the core of its mission, and all activities and goals are aimed at improving the patient’s experience and outcomes [ 2 , 10 ]. The mission and main clinical goals of the Pituitary MDT/PTCOE are summarised in Table 1 .…”

“…The concept of multidisciplinary team (MDT) and multidisciplinary medical care is recognised as best practice and has been increasingly used for a wide variety of conditions [ 1 , 2 ]. The contemporaneous management of complex and/or rare disorders relies mainly on MDT meetings and discussions among experienced healthcare professionals, which ensure timely, appropriate, specialized, and multidisciplinary decision-making, thus improving outcomes.…”