Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas
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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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Perioperative outcomes of a hydrocortisone protocol after endonasal surgery for pituitary adenoma resection
Tyler D Alexander,Sarah Collopy,Siyuan Yu,Michael Karsy,Chandala Chitguppi,Christopher J. Farrell,James J. Evans +6 more
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Endoscopic endonasal approach to pituitary adenomas: Impact on adenohypophyseal function. Study of 231 cases
TL;DR: In this paper , a study of patients with PAs operated by the same neurosurgeon through an endoscopic endonasal transsphenoidal (EET) approach in two Spanish tertiary hospitals in ten years was analyzed.
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Meta-analysis on the effect of pituitary adenoma resection on pituitary function.
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The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas
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Journal ArticleDOI
Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure
R. Sheaves,Paul J. Jenkins,P. Blackburn,A. H. Huneidi,F. Afshar,S. Medbak,Ashley B. Grossman,G. M. Besser,J. A. H. Wass +8 more
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.