Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas
TLDR
Patients with hypopituitarism after neurosurgery should be reassessed after surgery without substitution therapy, because practically half the preoperative pituitary hormone deficiencies recover postoperatively, eliminating the need for life-long substitution therapy.Abstract:
Surgery is the treatment of choice for many pituitary tumors; pituitary function may suffer after operation, but relief of pressure on the normal pituitary may also favor postoperative recovery of hypopituitarism. The aim of this study was to investigate the frequency of new appearance and recovery of hypopituitarism after neurosurgery and try to identify features associated with it. Pre- and postoperative anterior pituitary functions were investigated in 234 patients with pituitary adenomas (56 nonfunctioning, 71 PRL-secreting, 66 GH-secreting, 39 ACTH-secreting, 1 LH/FSH-secreting, and 1 TSH-secreting tumors). Eighty-eight new postoperative pituitary hypofunctions appeared in 52 patients (12 NF, 14 PRL-secreting, 15 GH-secreting, 10 ACTH-secreting, and 1 LH/FSH-secreting adenomas). They corresponded to 27% ACTH deficiencies (in 29 of the 107 patients with normal preoperative ACTH in whom postoperative evaluation was complete), 14.5% (15 of 103) new GH deficiencies, 10.5% (15 of 143; P < 0.0005, significantly less than ACTH deficiency) new TSH deficiencies, 16.5% (20 of 121) new gonadotropin deficiencies, and 13% (9 of 71) new PRL deficiencies. Preoperatively, 93 were deficient in at least 1 pituitary hormone; after surgery, 45 (48%) recovered between 1 and 3 hormones. The 2 patients with LH/FSH- and TSH-secreting macroadenomas did not recover pituitary function. Factors associated with a higher probability of postoperative pituitary function recovery were: no tumor rests on postoperative pituitary imaging (P = 0.001) and no neurosurgical (P = 0.001) or pathological evidence (P = 0.049) of an invasive nature. Tumor size did not differ significantly between those who did and those who did not recover pituitary function after surgery. Even if clear hypofunction is observed at initial work-up, patients should be reassessed after surgery without substitution therapy, because practically half the preoperative pituitary hormone deficiencies recover postoperatively, eliminating the need for life-long substitution therapy.read more
Citations
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Intraoperative MRI in transsphenoidal resection of invasive pituitary macroadenomas.
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TL;DR: Intraoperative MRI after maximal safe resection significantly improves the overall extent of resection in invasive pituitary adenomas independent of the surgical technique employed.
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Contemporary Management of Clinically Non-functioning Pituitary Adenomas: A Clinical Review:
Mussa H. Almalki,Maswood M Ahmad,Imad Brema,Khaled M. Aldahmani,Khaled M. Aldahmani,Nadeem Pervez,Sadeq Al-Dandan,Abdullah Alobaid,Salem A Beshyah +8 more
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Recovery of adrenal function after chronic secondary adrenal insufficiency in patients with hypopituitarism
TL;DR: A study was conducted to assess the longer term recovery rate of SAI in patients with pituitary disorders and found that longer term SAI recovery is slower than previously reported.
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The management of adult growth hormone deficiency syndrome.
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Anterior Pituitary Failure
TL;DR: An anterior pituitary failure is caused by several etiologic factors, such as mass lesions and their treatment, genetic mutations, infiltrative and infectious disease, and traumatic brain injury.
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Journal ArticleDOI
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TL;DR: The results of transsphenoidal pituitary surgery for acromegaly were analyzed to assess the longer‐term outcome for patients not offered further treatment when post‐operative levels of GH < 5 mU/l were achieved.