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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Aetiology, diagnosis, and management of hypopituitarism in adult life
V K B Prabhakar,Stephen M Shalet +1 more
TL;DR: The causes, clinical features, and the management of hypopituitarism including endocrine replacement therapy are considered in this review article.
Journal ArticleDOI
Radiotherapy for nonfunctioning pituitary adenomas: from conventional to modern stereotactic radiation techniques
Giuseppe Minniti,Marie Lise Jaffrain-Rea,Mattia Falchetto Osti,Giampaolo Cantore,Riccardo Maurizi Enrici +4 more
TL;DR: A review of the literature suggests that new radiation techniques offer safe and effective treatment for recurrent or residual pituitary adenomas; however longer follow-up is necessary to confirm the excellent tumour control and the potential reduction of long-term radiation toxicity.
Journal ArticleDOI
Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging.
TL;DR: The use of iMRI for transsphenoidal resection leads to low recurrence rates, even in case of invasive tumours, and distinctly more patients show long tumour-free follow-ups.
Journal ArticleDOI
Evolving criteria for post-operative biochemical remission of acromegaly: can we achieve a definitive cure? An audit of surgical results on a large series and a review of the literature.
Giuseppe Minniti,Marie Lise Jaffrain-Rea,Vincenzo Esposito,Antonio Santoro,Guido Tamburrano,G. P. Cantore +5 more
TL;DR: It is concluded that TSS is able to achieve a biochemical remission in more than half of acromegalic patients, and that the current criteria for remission seem to indicate a cure in most cases.
Journal ArticleDOI
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Primary Management of Patients With Nonfunctioning Pituitary Adenomas.
Joshua Lucas,Mary E. Bodach,Luis M. Tumialán,Nelson M. Oyesiku,Chirag G. Patil,Zachary Litvack,Manish K. Aghi,Gabriel Zada +7 more
TL;DR: Surgical resection is recommended as the preferred primary intervention for symptomatic NFPAs based on the available evidence and limited and inconsistent reports are available for alternative treatment strategies, including radiation, medical treatment, and observation.
References
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Journal ArticleDOI
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Journal ArticleDOI
Outcome of transsphenoidal surgery for acromegaly using strict criteria for surgical cure
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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.