Microsurgical Therapy of Pituitary Adenomas

Endocrine. 2018 Jan;59(1):72-81. doi: 10.1007/s12020-017-1458-3. Epub 2017 Oct 24.

Abstract

Purpose: We report the efficacy and safety of transsphenoidal microsurgery in a large and homogeneous cohort of patients with pituitary adenomas (PAs) treated at a single Institute by a single neurosurgeon.

Methods: A total of 2145 consecutive patients undergoing first surgery for a PA were included: 795 (37.1%) had a nonfunctioning pituitary adenoma (NFPA), 595 (27.7%) acromegaly, 496 (23.1%) Cushing's disease, 208 (9.7%) a PRL-secreting adenoma, and 51 patients (2.4%) a TSH-secreting adenoma. Remission was achieved when strict hormonal and radiological criteria were met.

Results: Early surgical remission was achieved in 66% of acromegalic patients, 79.6% of patients with Cushing's disease, 64.4% of prolactinomas, 74.5% of patients with a TSH-secreting adenoma, and 66.9% of NFPAs. The mean (±SE) follow-up was 60.1 ± 1.3 months. The recurrence-free survival at 10 years was 78.2% in acromegalic patients, 68.1% in prolactinomas, 74.3% in Cushing's disease, 70.3% in TSH-secreting adenomas, and 75.3% in NFPAs. Preoperative hypoadrenalism recovered in 35.3%, hypogonadism in 43.3% and hypothyroidism in 37.4% of patients with impaired function before surgery. The mortality rate was 0.2% and major morbidity 2.1%. New onset hypoadrenalism occurred after surgery in 2.5% of patients at risk, hypogonadism in 4.1%, and hypothyroidism in 1.8%. Permanent diabetes insipidus (DI) occurred in 0.9% of patients.

Conclusions: In experienced hands, transsphenoidal microsurgery for PAs achieves remission in most patients with a low complication rate. Pituitary function is preserved in most cases and can recover in more than one-third of patients with preoperative hypopituitarism.

Keywords: Pituitary adenomas; Surgical complications.; Surgical results; Transsphenoidal surgery.

MeSH terms

  • Acromegaly / epidemiology
  • Acromegaly / surgery
  • Adenoma / epidemiology
  • Adenoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Child
  • Female
  • Humans
  • Male
  • Microsurgery / methods*
  • Microsurgery / statistics & numerical data
  • Middle Aged
  • Neurosurgeons
  • Neurosurgical Procedures / methods*
  • Neurosurgical Procedures / statistics & numerical data
  • Pituitary Neoplasms / epidemiology
  • Pituitary Neoplasms / surgery*
  • Prolactinoma / epidemiology
  • Prolactinoma / surgery
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult