Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas

Abstract

A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.

Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal

“…Two other studies of microscopically removed NFPAs, one by Nelson et al 34 (among 83 patients, 35% improved, 32.1% worsened, and 32.1% stabilized), and another by Jane and Laws 20 (among 1000 patients, 27% improved), reported less optimistic results that more closely resemble our own experience (improved or normalized in 25%, unchanged in 46%, and worsened in 29%). Endocrinological data for endoscopy in NFPA surgery are sparse.…”

Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging

“…In the present study, the final postoperative endocrinological recovery rate of single axes after a mean follow-up of 5.6±1.9 was 66 %, whereas new pituitary deficits were found in 26 % of the patients. The rate of postoperative hypopituitarism in series on transsphenoidal tumour resections is commonly below 20 % [1,5,21,23,27,36,69]; however, higher rates have been described [6,35,61], especially in the case of large tumours and NFA [26,36,69,92]. Radiotherapy-which is known to cause hypopituitarism [53]-was used in 27 % of the present patients with late loss of pituitary function and may have influenced the outcome.…”

Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma

“…Compared with the rates reported in the literature, this seems quite high. Higher rates for postoperative dysfunction have been described in various studies [9,22,35], especially in patients with hormonally inactive adenomas (up to 40%) [16,23,41,56]. Total tumour resection is a significant factor for postoperative recovery of hypopituitarism [56].…”

“…The rate of postoperative hypopituitarism in series on transsphenoidal tumour resections is commonly below 20% [1,8,14,15,17,23,41]. Higher rates have been described [9,22,35]; especially in the case of larger and hormonally inactive tumours [16,23,41,56], pituitary apoplexy [48,52] and transcranial surgery [41]. Patients with intraoperative cerebrospinal fluid (CSF) leaks, craniopharyngiomas or Rathke's cleft cysts have a higher risk for transient or permanent diabetes insipidus [36].…”