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

Marić, Andreja and Kruljac, Ivan and Čerina, Vatroslav and Pećina, Hrvoje Ivan and Šulentić, Petra and Vrkljan, Milan (2012) Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience. Croatian Medical Journal, 53 (3). pp. 224-33. ISSN 0353-9504

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Abstract

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 in 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.

Item Type: Article
MeSH: 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
Departments: Katedra za internu medicinu
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Marić, AndrejaUNSPECIFIED
Kruljac, IvanUNSPECIFIED
Čerina, VatroslavUNSPECIFIED
Pećina, Hrvoje IvanUNSPECIFIED
Šulentić, PetraUNSPECIFIED
Vrkljan, MilanUNSPECIFIED
Date: June 2012
Date Deposited: 28 Dec 2012 12:25
Last Modified: 28 Dec 2012 12:25
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/1724

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