Pituitary surgery’s epidemiology using a national inpatient database in Japan

Hattori, Yujiro; Tahara, Shigeyuki; Aso, Shotaro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo; Morita, Akio

doi:10.1007/s00701-020-04270-4

Cited by 18 publications

(10 citation statements)

References 28 publications

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“…Treatment at a high-volume center by an experienced surgeon and tumor characteristics such as detection on MRI, noninvasiveness, and size <1 cm appear to correlate with higher remission rates; 138,143 whether there is a potential incremental benefit with an endoscopic approach for macroadenomas remains unclear. 144,145 Overall, complication rates are low, with more experienced surgeons having even lower rates. 146,147 New-onset hypopituitarism, seen in approximately 10% of patients, as well as permanent diabetes insipidus (DI), cerebrospinal fluid (CSF) leak, and VTE seen in <5% of patients, are the most common complications; peri-operative mortality is <1%.…”

Section: Introductionmentioning

confidence: 99%

Consensus on diagnosis and management of Cushing's disease: a guideline update

Fleseriu

Auchus

Bancos

et al. 2021

The Lancet Diabetes & Endocrinology

449

538

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Section: Introductionmentioning

confidence: 99%

Consensus on diagnosis and management of Cushing's disease: a guideline update

Fleseriu

Auchus

Bancos

et al. 2021

The Lancet Diabetes & Endocrinology

449

538

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“…Endoscopic transsphenoidal surgery (ETSS) has become a generally accepted surgical approach for pituitary and parasellar tumors since the recent improvement in endoscope performance ( 1 ). Injury to the internal carotid artery (ICA) accounts for approximately 1% of complications during transsphenoidal surgery but seems to occur less frequently in ETSS than in microscopic transsphenoidal surgery ( 2 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

Injury to the Extrasellar Portion of the Internal Carotid Artery during Endoscopic Transsphenoidal Surgery: A Case Report

Teramoto

Tahara²,

Murai³

et al. 2022

Front. Surg.

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BackgroundInjury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known.Case PresentationA 65-year-old man with an incidental pituitary tumor underwent ETSS. The petrous portion of the left ICA was injured during resection of the sphenoid septum connected with left carotid prominence using a cutting forceps. Bleeding was too heavy for simple hemostatic techniques. Hemostasis using a crushed muscle patch was tried unsuccessfully during controlling of the bleeding. Eventually, the injured site of the ICA was covered with cotton patties followed by closing with a vascularized pedicled nasoseptal flap. Cerebral angiography immediately after surgery showed no extravasation from the injured site of the left ICA petrous portion. However, a carotid-cavernous sinus fistula originating from the injured ICA site was detected 7 days after surgery, so the vascular reconstructive surgery combined with left ICA occlusion was performed. The overall postoperative course was uneventful.ConclusionWe believe that emergency application of the cottonoids may be effective for hemostasis against ICA injury in the extrasellar portion during ETSS, but further vascular reconstruction combined with ICA occlusion on the injured side and removal of the cottonoids would be required.

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“…Hypercortisolism is associated with higher risks of metabolic, musculoskeletal, immunological, and neuropsychiatric complications, which result in significant morbidity and mortality. Therefore, CD requires early diagnosis and treatment, and transsphenoidal surgery (TSS) is currently the treatment of choice (2,3). The reported remission rates are between 68% and 98% (4).…”

Section: Introductionmentioning

confidence: 99%

Management of thyrotoxicosis occurring after surgery for Cushing’s disease: a case series

Jiang¹,

Yang²,

Feng³

et al. 2021

Gland Surg

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Background: Thyrotoxicosis is a rare complication of surgery for Cushing's disease (CD). In clinical practice, given the rarity of this condition, patients may be misdiagnosed, and thus not treated appropriately.This study describes the clinical features and management of thyrotoxicosis in this context. Methods:We retrospectively screened a pituitary database for CD patients who underwent surgery at Peking Union Medical College Hospital between 2010 and 2017. The electronic medical records and documentation of 732 patients were searched in order to identify instances of thyrotoxicosis.Results: Fourteen patients developed postoperative thyrotoxicosis after CD remission, representing 1.9% of all the CD patients who underwent surgery and 2.5% of the CD patients who were in remission after surgery. The onset of thyrotoxicosis occurred at a median of 3.5 months after surgery. At the onset, 13 patients (92.9%) were on a maintenance dose of hydrocortisone and were managed using a higher dose of hydrocortisone. One patient had normal adrenal function and was managed by observation first, then using anti-thyroid drugs. Thyrotoxicosis was transient in all but one patient, and lasted 1.9±0.7 months (range, 1- months).Conclusions: Thyrotoxicosis is a rare complication that develops during the recovery period following surgery for CD. It occurs only after the surgical resolution of hypercortisolism, and in particular alongside adrenal insufficiency during the 4 months following CD remission. Awareness of this situation should be promoted among physicians, and patients should be managed on the basis of the clinical setting and manifestation.

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Pituitary surgery’s epidemiology using a national inpatient database in Japan

Cited by 18 publications

References 28 publications

Consensus on diagnosis and management of Cushing's disease: a guideline update

Consensus on diagnosis and management of Cushing's disease: a guideline update

Injury to the Extrasellar Portion of the Internal Carotid Artery during Endoscopic Transsphenoidal Surgery: A Case Report

Management of thyrotoxicosis occurring after surgery for Cushing’s disease: a case series

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