Endocrine Outcomes Following Endoscopic Transsphenoidal Pituitary Surgery in Erbil, Iraq

Abstract

Objective The impact of endoscopic transsphenoidal pituitary surgery (ETSs) on endocrine function is a critical concern of surgical treatment of pituitary tumors. This study evaluated post-ETSs pituitary disease control (DC), development of early and late new hormonal deficiencies, and recovery of pre-existing hormonal deficiency. Additionally, studied the preoperative factors that influence post-ETSs outcome. Methods A prospective cohort study conducted in neuroendocrine field in Erbil city from April 2023 to April 2024. The study included 35 patients who were assigned for ETSs after exclusion of those with prior neurosurgical intervention, radiation, or drugs affecting pituitary function. Initial clinical evaluation, endocrine tests and radiological imaging performed pre-ETSs, then at early postoperative period and later follow up scheduled at one-, three-, and six-month interval. Results Post-ETSs, DC achieved in 20 (57.1%) of patients. At six-month follow up, about 10/18 (55.5%) patients recovered at least one hormone postoperatively with gonadal axis was the most frequent 5 (14.3%), while new hormonal deficiencies documented in 12 (34.3%) patients, among which prolonged Diabetes insipidus (DI) was the most frequently encountered 11 (31.4%). Early post-ETSs water dysregulation significantly prolonged hospital stay (p-value 0.035). Tumor size, knops classification and surgeon experience were the main variables associated with endocrine outcome. Conclusion In Iraq, Erbil city, DC rate was lower than previous studies, and development of new hormonal deficiencies was higher and contributed to prolonged DI. However, a considerable number of patients had recovery of pre-existing hormonal deficiencies compared to prior studies. These findings necessitate revision of our surgical management.