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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Recovery of Pituitary Function in the Late-Postoperative Phase after Pituitary Surgery: Results of Dynamic Testing in Patients with Pituitary Disease by ITT 3 and 12 after Surgery
TL;DR: Dynamic testing 3 and 12 months after transsphenoidal pituitary surgery results in a change in classification by ITT in a relevant proportion of patients, and should be repeated during follow-up.
Perioperative Management of the Pituitary Patient
B Y J Eannette,G Oguen,Lawrence A. Leiter,Gillian L. Booth,Alice Cheng,Philip W. Connelly,Christine Derzko,Richard E. Gilbert,Jeannette Goguen,Loren Grossman,Amir Hanna,Sophie A. Jamal,Maria Kraw,Tim Murray,Dominic Ng,William Singer,Vlad Vuksan,Qinghua Wang,Tom Wolever +18 more
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Vascular Diseases of the Endocrine Organs: Special Considerations
Susan M. Webb,Ana M. Wägner +1 more
TL;DR: This chapter will deal with a massive adrenal or pituitary vascular insult and the glucocorticoids, two entities that are associated with acute hormonal deficiencies that are life threatening.
References
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Dopamine agonists and pituitary tumor shrinkage
TL;DR: Preliminary evidence suggests that dopamine agonists may restrain the growth of some functionless tumors; most of these tumors, however, can be satisfactorily debulked using transsphenoidal surgery, although the number of tumors studied is small.
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TL;DR: There is a high incidence of anterior pituitary hormone deficiencies in patients treated surgically forpituitary tumours and the incidence increases after external radiotherapy and endocrine testing is recommended on an annual basis.
Journal ArticleDOI
Reversible Hypopituitarism in Patients with Large Nonfunctioning Pituitary Adenomas
TL;DR: It is suggested that compression of the portal circulation is a possible mechanism for hypopituitarism in this setting and significant improvement in pituitsary function may occur after surgical adenomectomy for nonsecreting pituitary tumors.
Journal ArticleDOI
The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas
TL;DR: Data indicate that trans‐sphenoidal microsurgery is an effective and safe initial treatment for patients with nonsecreting pituitary adenoma and may reverse hypopituitarism.
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.