Pituitary Hormonal Loss and Recovery After Transsphenoidal Adenoma Removal

Fatemi, Nasrin; Dusick, Joshua R.; Mattozo, Carlos Alberto; McArthur, David L.; Cohan, Pejman; Boscardin, John; Wang, Christina; Swerdloff, Ronald S.; Kelly, Daniel F.

doi:10.1227/01.neu.0000325725.77132.90

Cited by 194 publications

(166 citation statements)

References 46 publications

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“…In that report, an aggressive approach did not aggravate but rather improved postoperative hypopituitarism. Even in the GH axis, there was no difference in the incidence of development of GHD, compared with other studies (23,24). Specifically, the incidence of GHD was 9.8% in this study, compared with 6.1 and 9.1% in other studies (17,18).…”

Section: European Journal Of Endocrinologycontrasting

confidence: 79%

Clinical predictors of GH deficiency in surgically cured acromegalic patients

Ku¹,

Hong²,

Kim³

et al. 2014

European Journal of Endocrinology

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Objective: Even in patients with cured acromegaly, GH deficiency (GHD) after transsphenoidal adenomectomy (TSA) adversely affects body composition and inflammatory biomarkers of cardiovascular risk. In this study, clinical parameters for predicting GHD after TSA in 123 cured acromegalic patients were investigated. Design and methods: GH levels were measured at 6, 12, 18, 24, 48, and 72 h after TSA and serial insulin tolerance tests were conducted at 6 months, 2 years, and then every 2 years after TSA. Results: GHD was found in 12 patients (9.8%) at 4.1 (range: 0.5-4.1) years after TSA. IGF1 levels were significantly lower at 6 months after TSA in GHD group than intact GH group (175.9 vs 316.8 mg/l, range: 32.0-425.0 and 96.9-547.3 respectively, PZ0.008). Adenomas involving both sides of the pituitary gland were significantly more frequent in GHD patients (29.7 vs 83.3%; PZ0.002). Furthermore, immediate postoperative 72-h GH levels after TSA were significantly lower (0.17 vs 0.45, range: 0.02-0.93 and 0.02-5.95 respectively, PZ0.019) in GHD patients. In multiple logistic regression analysis, bilaterality of tumor involvement (odds ratio (OR)Z10.678, PZ0.003; 95% CIZ2.248-50.728) and immediate postoperative 72-h GH level (ORZ0.079, PZ0.047; 95% CIZ0.006-0.967) showed significant power for predicting GHD. Conclusions: These data suggest that bilateral involvement of a pituitary adenoma and severely decreased immediate postoperative serum GH levels at 72 h after TSA may be independent risks factor for accelerated GHD in acromegalic patients.

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Section: European Journal Of Endocrinologycontrasting

confidence: 79%

Clinical predictors of GH deficiency in surgically cured acromegalic patients

Ku¹,

Hong²,

Kim³

et al. 2014

European Journal of Endocrinology

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“…The rate of postoperative hypopituitarism in series on transsphenoidal tumor resections is commonly below 20%; 1,4,18,21,24,30,56 however, higher rates may be seen in the case of larger tumors or NFA. 23,30,56,76 GTR was reported to be a significant factor for postoperative recovery from hypopituitarism. 76 It may be argued, that the comparably low recovery rate in the present study was influenced by the relatively low GTR rate.…”

Section: 21mentioning

confidence: 99%

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Berkmann

Schlaffer

Nimsky

et al. 2014

JNS

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Object. The loss of anatomical landmarks, frequently invasive tumor growth, and tissue changes make transsphenoidal reoperation of nonfunctioning pituitary adenomas (NFAs) challenging. The use of intraoperative MRI (iMRI) may lead to improved results. The goal of this retrospective study was to evaluate the impact of iMRI on transsphenoidal reoperations for NFA.Methods. Between September 2002 and July 2012, 109 patients underwent reoperations in which 111 transsphenoidal procedures were performed and are represented in this study. A 1.5-T Magnetom Sonata Maestro Class scanner (Siemens) was used for iMRI. Follow-up iMRI scans were acquired if gross-total resection (GTR) was suspected or if no further removal seemed possible.Results. Surgery was performed for tumor persistence and regrowth in 26 (23%) and 85 (77%) patients, respectively. On the initial iMRI scans, GTR was confirmed in 19 (17%) patients. Remnants were located as follows: 65 in the cavernous sinus (71%), 35 in the suprasellar space (38%), 9 in the retrosellar space (10%). Additional resection was possible in 62 (67%) patients, resulting in a significant volume reduction and increased GTR rate (49%). The GTR rates of invasive tumors on initial iMRI and postoperative MRI (poMRI) were 7% and 25%, respectively. Additional remnant resection was possible in 64% of the patients. Noninvasive tumors were shown to be totally resected on the initial iMRI in 31% of cases. After additional resection for 69% of the procedures, the GTR rate on poMRI was 75%. Transcranial surgery to resect tumor remnants was indicated in 5 (5%), and radiotherapy was performed in 29 (27%) patients. After GTR, no recurrence was detected during a mean follow-up of 2.2 ± 2.1 years.Conclusions. The use of iMRI in transsphenoidal reoperations for NFA leads to significantly higher GTR rates. It thus prevents additional operations and reduces the number of tumor remnants. The complication rates do not exceed the incidences reported in the literature for primary transsphenoidal surgery. If complete tumor resection is not possible, iMRI guidance can facilitate tumor volume reduction. (http://thejns.org/doi/abs/10.3171/2014.6.JNS131994) key WorDS • pituitary adenoma • intraoperative MRI • reoperation • tumor recurrence • transsphenoidal surgery • pituitary surgeryAbbreviations used in this paper: DI = diabetes insipidus; FSH = follicle-stimulating hormone; GKS = Gamma Knife surgery; GTR = gross-total resection; iMRI = intraoperative MRI; LH = luteinizing hormone; NFA = nonfunctioning pituitary adenoma; poMRI = postoperative MRI; VA = visual acuity; VF = visual field. J Neurosurg / Volume 121 / November 2014Intraoperative MRI for transsphenoidal reoperations 1167 ly.29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear. The aim of this retrospective study was to evaluate the impact of iMRI on the extent of transsphenoidal reoperations in patients presenting with recurrent or persisting NFA. Methods Patient Population and Data Asse...

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“…Studies investigating whether pituitary function improves at all after transsphenoidal surgery for NFAs without specifying individual axes have reported considerably variable rates, ranging from at most 20% of patients 16,18 to up to 50% of patients. 3,6 Studies that have examined endocrine recovery by a specific axis after NFA surgery 1,5,13,17 have suggested that recovery varies by axis from 13% to 57%. These studies have identified factors associated with improvement in general (smaller adenomas, normal or slightly elevated prolactin, gross-total resection, and lack of tumor invasion) and improvement in individual axes (preoperative rise in serum thyroid-stimulating hormone [TSH] in response to thyrotropin-releasing hormone [TRH] stimulation; rise in serum LH after gonadotropin-releasing hormone [GnRH] stimulation).…”

mentioning

confidence: 99%

Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis

Jahangiri

Wagner

Han

et al. 2016

JNS

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aBBreViatiONS ACTH = adrenocorticotropic hormone; FSH = follicle-stimulating hormone; GH = growth hormone; GnRH = gonadotropin-releasing hormone; IGF-1= insulin-like growth factor-1; LH = luteinizing hormone; NFA = nonfunctional adenoma; T4 = thyroxine; TRH = thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone. SuBmitted October 10, 2014. accepted January 13, 2015. iNclude wheN citiNg Published online August 7, 2015; DOI: 10.3171/2015.1.JNS141543. diSclOSure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. * Mr. Jahangiri and Mr. Wagner contributed equally to this work. OBJectiVe The impact of transsphenoidal surgery for nonfunctional pituitary adenomas (NFAs) on preoperative hypopituitarism relative to the incidence of new postoperative endocrine deficits remains unclear. The authors investigated rates of hypopituitarism resolution and development after transsphenoidal surgery. methOdS Over a 5-year period, 305 transsphenoidal surgeries for NFAs performed at The California Center for Pituitary Disorders were retrospectively reviewed. reSultS Patients with preoperative endocrine deficits (n = 153, 50%) were significantly older (mean age 60 vs 54 years; p = 0.004), more frequently male (65% vs 44%; p = 0.0005), and had larger adenomas (2.4 cm vs 2.1 cm; p = 0.02) than patients without preoperative deficits (n = 152, 50%). Of patients with preoperative endocrine deficits, 53% exhibited symptoms. Preoperative deficit rates were 26% for the thyroid axis; 20% and 16% for the male and female reproductive axes, respectively; 13% for the adrenocorticotropic hormone (ACTH)/cortisol axis, and 19% for the growth hormone (GH)/ insulin-like growth factor-1 (IGF-1) axis. Laboratory normalization rates 6 weeks and 6 months after surgery without hormone replacement were 26% and 36% for male and 13% and 13% for female reproductive axes, respectively; 30% and 49% for the thyroid axis; 3% and 3% for the cortisol axis; and 9% and 22% for the IGF-1 axis (p < 0.05). New postoperative endocrine deficits occurred in 42 patients (13.7%). Rates of new deficits by axes were: male reproductive 3% (n = 9), female reproductive 1% (n = 4), thyroid axis 3% (n = 10), cortisol axis 6% (n = 19), and GH/IGF-1 axis 4% (n = 12). Patients who failed to exhibit any endocrine normalization had lower preoperative gland volumes than those who did not (0.24 cm 3 vs 0.43 cm 3 , respectively; p < 0.05). Multivariate analyses revealed that no variables predicted new postoperative deficits or normalization of the female reproductive, cortisol, and IGF-1 axes. However, increased preoperative gland volume and younger age predicted the chances of a patient with any preoperative deficit experiencing normalization of at least 1 axis. Younger age and less severe preoperative hormonal deficit predicted normalization of the thyroid and male reproductive axes (p < 0.05). cONcluSiONS After NFA resection, endocrine normalization rates in this study varied with the horm...

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Pituitary Hormonal Loss and Recovery After Transsphenoidal Adenoma Removal

Cited by 194 publications

References 46 publications

Clinical predictors of GH deficiency in surgically cured acromegalic patients

Clinical predictors of GH deficiency in surgically cured acromegalic patients

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis

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