Disparities in Postoperative Endocrine Outcomes After Endoscopic-Assisted Transsphenoidal Pituitary Adenoma Resection

Chhitij Tiwari; Eugene Maung; Aaron Gelinne; Nathan Quig; Brian Thorp; Adam Zanation; Matthew Ewend; Deanna Sasaki-Adams; Carolyn Quinsey

doi:10.7759/cureus.31934

Disparities in Postoperative Endocrine Outcomes After Endoscopic-Assisted Transsphenoidal Pituitary Adenoma Resection

Cureus. 2022 Nov 27;14(11):e31934. doi: 10.7759/cureus.31934. eCollection 2022 Nov.

Authors

Chhitij Tiwari¹, Eugene Maung¹, Aaron Gelinne¹, Nathan Quig¹, Brian Thorp², Adam Zanation^{2

3}, Matthew Ewend¹, Deanna Sasaki-Adams¹, Carolyn Quinsey¹

Affiliations

¹ Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, USA.
² Department of Otolaryngology - Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA.
³ Department of Otolaryngology - Head and Neck Surgery, Carolina Ear Nose & Throat, Hickory, USA.

Abstract

Objectives Socioeconomic factors can influence morbidity in patients with pituitary adenoma. This study aims to identify associations between socioeconomic factors and postoperative outcomes in patients with pituitary adenomas. Methods A retrospective medical chart review was conducted on adult patients who underwent resection of purely sellar nonfunctional and functional pituitary adenomas between May 1, 2014, and May 31, 2020, at the University of North Carolina Medical Center. The main outcome measures included the incidence of postoperative diabetes insipidus (PDI), postoperative hyponatremia (PHN), and postoperative hypopituitarism (PHP). Outcome measures were analyzed using univariate and multivariate analyses against preoperative tumor volume as well as socioeconomic and demographic factors (self-identified race/ethnicity, age, gender, address assessed by the Area Deprivation Index (ADI), and insurance status). Results On univariate analysis, patients of Hispanic race/ethnicity and patients living in more disadvantaged neighborhoods had an increased incidence of postoperative diabetes insipidus. Patients who experienced PDI were significantly younger on average in both univariate and multivariate analyses. When analyzed further, patients of Hispanic race/ethnicity were significantly younger and more likely to be uninsured compared to their respective racial/ethnic counterparts. No significant correlations were found for PHN or PHP. Conclusions Patients of Hispanic race/ethnicity and patients living in more disadvantaged neighborhoods were more likely to experience PDI. This finding, when combined with findings regarding age and insurance status, suggests complex disparities in medical care that are confirmed or corroborated by prior literature. These results may enhance clinicians' management of patients from disadvantaged socioeconomic backgrounds through increased awareness of disparities and the provision of resources for assistance.

Keywords: diabetes insipidus; endoscopic sinus surgery; pituitary adenoma; skull base; socioeconomic disparities.