Biochemical remission and recurrence rate of secreting pituitary adenomas after transsphenoidal adenomectomy: long-term endocrinologic follow-up results

Surg Neurol. 2007 Nov;68(5):513-8; discussion 518. doi: 10.1016/j.surneu.2007.05.057.


Background: Transsphenoidal surgery is safe and effective in patients with secreting pituitary adenomas; however, variable outcomes have been reported according to the different criteria used to define the biochemical remission of hormone hypersecretion. We report the long-term endocrinologic follow-up results of a large cohort of patients who underwent TSS for secreting pituitary adenomas according to the most recent stringent criteria of cure.

Methods: Two hundred ten consecutive patients were operated on by TSS between 1995 and 2004 for a secreting pituitary adenoma (65 PRL-, 109 GH-, and 36 ACTH-secreting adenomas) and were considered for the study.

Results: The overall remission rate was 65% for the whole series, being 64%, 61%, and 75% for PRL-, GH-, and ACTH-secreting adenomas, respectively. Eighty-six percent of microadenomas and 53% of macroadenomas were cured by surgery. Remission rates were significantly higher in GH- and ACTH-secreting pituitary macroadenomas than in macroprolactinomas. At a median follow-up of 56 months, tumor recurrence was 0%, 11%, and 14% for GH-, ACTH-, and PRL-secreting tumors. Tumor size, cavernous sinus invasion, and high hormone levels were negatively correlated to the outcome.

Conclusion: Transsphenoidal surgery remains an effective treatment for secreting pituitary tumors according to the most recent criteria of cure. Patients with PRL- or ACTH-secreting adenomas may recur after apparently successful surgery, thereby justifying long-term careful endocrinologic follow-up.

MeSH terms

  • Adenoma / blood
  • Adenoma / metabolism
  • Adenoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperpituitarism / blood
  • Hyperpituitarism / etiology
  • Hyperpituitarism / prevention & control*
  • Male
  • Middle Aged
  • Pituitary Hormones, Anterior / blood
  • Pituitary Hormones, Anterior / metabolism
  • Pituitary Neoplasms / blood
  • Pituitary Neoplasms / metabolism
  • Pituitary Neoplasms / surgery*
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome


  • Pituitary Hormones, Anterior