Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience

Scientific paper - Original scientific paper

• Author: Andreja Marić
• Author: Ivan Kruljac
• Author: Vatroslav Čerina
• Author: Hrvoje Ivan Pećina
• Author: Petra Šulentić
• Author: Milan Vrkljan
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

AIM:

To analyze early remission, complications, and pituitary function recovery after pure endoscopic endonasal transsphenoidal surgery (PEETS), a novel method in pituitary adenoma treatment. ----- METHODS:

Testing of all basal hormone values and magnetic resonance imaging (MRI) were performed preoperatively and postoperatively (postoperative MRI only in nonfunctioning adenomas) in 117 consecutive patients who underwent PEETS in the period between 2007 and 2010. The series consisted of 21 somatotroph adenomas, 61 prolactinomas, and 4 corticotroph and 31 nonfunctioning adenomas. Sixty-three were macroadenomas and 54 were microadenomas. Remission was defined as hormonal excess normalization on the seventh postoperative day in functioning adenomas and as normal MRI findings approximately four months postoperatively in nonfunctioning adenomas. The presence of hypogonadism, growth hormone deficiency, and hypothyroidism was assessed on the seventh postoperative day. Hypocortisolism was assessed through necessity for replacement therapy within 18 months postoperatively. ----- RESULTS:

Remission was achieved in 84% of patients: in 100% of microadenoma and 70% of macroadenoma patients (P<0.001, odds ratio [OR], 28.16, 95% confidence interval [CI], 1.61-491.36), respectively. Endocrinological complications occurred in 17.1% of patients: in 9% of microadenoma and 24% of macroadenoma patients (P=0.049, OR, 3.06; 95% CI, 1.03-9.08). Duration of empirical hydrocortisone replacement therapy was significantly shorter in microadenoma patients (P<0.001). Thirty-five percent of preoperatively present hormonal deficiencies improved after the surgery. Between tumor types there were no significant differences in remission, complications, and normal pituitary function recovery. ----- CONCLUSION:

Patients with microadenomas had higher remission and lower complication rates following PEETS, emphasizing the necessity for early detection and treatment of pituitary adenomas. PEETS is a discussion-worthy method for microprolactinoma treatment.

Abstract (croatian)

Endokrinološki ishodi čistog endoskopskog transsfenoidalnog kirurškog zahvata: iskustva iz Hrvatskog referentnog centra za bolesti hipofize ----- Cilj Analizirati ranu remisiju, komplikacije i oporavak rada hipofize nakon čistog endoskopskog transsfenoidalnog kirurškog zahvata (engl. PEETS), novog postupka u liječenju adenoma hipofize. ----- Postupci Provjerili smo bazalne hormonske vrijednosti i napravili snimanje magnetskom rezonancijom prije i nakon operacije (MRI nakon operacije samo u slučaju nefunkcionalnih adenoma) kod 117 uzastopnih pacijenata koji su bili podvrgnuti zahvatu PEETS u razdoblju između 2007. i 2010. Naša skupina sadržavala je 21 somatotropni adenom, 61 prolaktinom, 4 kortikotropna adenoma i 31 nefunkcionalni adenom. Šezdeset i tri su bili makroadenomi, a 54 mikroadenomi. Remisiju smo definirali kao normalizaciju viška hormona 7 dana nakon operacije kod funkcionalnih adenoma i kao normalne MRI nalaze otprilike 4 mjeseca nakon operacije kod nefunkcionalnih adenoma. Utvrdili smo i prisutnost hipogonadizma, manjka hormona rasta i hipotiroidizma 7 dana nakon operacije. Hipokortizolizam utvrđen je kroz potrebu za nadomjesnom terapijom 18 mjeseci nakon operacije. ----- Rezultati Osamdeset i četiri posto pacijenata postiglo je remisiju: 100% pacijenata s mikoradenomima i 70% pacijenata s makroadenomima (P<0,001, omjer izgleda [engl, OR], 28,16, 95% raspon pouzdanosti [engl, CI], 1,61-491,36). Endokrinološke posljedice su bile prisutne kod 17,1% pacijenata: 9% pacijenata s mikoradenomima i 24% s makroadenomima (P=0,049, OR, 3,06; 95% CI, 1,03-9,08). Nadomjesna terapija hidrokortizonom bila je značajno kraća kod pacijenata s mikroadenomima (P<0,001). Nakon operacije popravilo se 35% hormonalnih deficijencija prisutnih prije operacije. Nije bilo značajnih razlika u pojavi remisije, komplikacija i oporavku funkcije hipofize između pacijenata s različitim vrstama tumora. ----- Zaključak Pacijenti s mikroadenomima imali su višu stopu remisije i manje komplikacija nakon PEETS zahvata, što ukazuje na potrebu ranog otkrivanja i liječenja adenoma hipofize. PEETS je metoda koju bi trebalo uzeti u obzir pri liječenju mikroprolaktinoma.

• Keywords (english): Adenoma/pathology; Adenoma/surgery; Adolescent; Adult; Aged; Aged, 80 and over; Confidence Intervals; Croatia; Endoscopy; Feasibility Studies; Female; Growth Hormone-Secreting Pituitary Adenoma/pathology; Growth Hormone-Secreting Pituitary Adenoma/surgery; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Odds Ratio; Pituitary Gland/pathology; Pituitary Gland/surgery; Pituitary Neoplasms/pathology; Pituitary Neoplasms/surgery; Prolactinoma/pathology; Prolactinoma/surgery; Young Adult
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Croatian Medical Journal
• Numbering: vol. 53, no. 3, pp. 224-233
• p-ISSN: 0353-9504
• DOI: https://doi.org/10.3325/cmj.2012.53.224
• URN:NBN: urn:nbn:hr:105:842464
• Publication: 2012-06
• Document URL: http://www.cmj.hr/2012/53/3/22661135.htm
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-27 19:35:25