Outcomes of Transphenoidal Surgery in non-functioning pituitary adenomas
D Newman, B Jones, K Meeran, E Hatfield, N Martin, N Mendoza
Charing Cross Hospital, Imperial College.
Objective: Our aim was to clarify the outcome of transphenoidal pituitary surgery in patients with a non-functioning pituitary adenoma.
Patients: We assessed the outcomes for all patients undergoing trans-sphenoidal surgery performed by the same pituitary surgeon for a non-functioning pituitary adenoma over 1 year (01/04/2013 -31/03/2014) at a tertiary centre. Forty patients with this tumour type were identified as undergoing surgery during this period. Twenty six were included in the final analysis. Exclusion criteria included insufficient information about their clinical and radiological outcomes during the audit period, re-do pituitary surgery.
Methods: Outcomes were assessed retrospectively using post-operative endocrine assessment, MRI, clinical progress (clinical notes) and post-operative pituitary MDT discussions.
Primary outcome measures: Degree of resection of the original tumour, determined by a single Consultant Neuroradiologist using dedicated pituitary MRI.
New post-operative pituitary hormone deficiencies.
Results:16/26 patients had complete or near-complete resection radiologically. 10 patients had an incomplete resection, with 6 of these having cavernous sinus invasion pre-operatively and 3 with suprasellar residual disease.
Regarding new hormone deficiencies post-operatively: no patients developed post-operative secondary hypogonadism or diabetes insipidus. 18% developed secondary hypothyroidism post-operatively (3/17), 38% developed Growth Hormone deficiency (9/24) and 45% developed secondary adrenal insufficiency (9/20).
Conclusion: Consistent with previous studies, the presence of pre-operative cavernous or sphenoid sinus involvement makes incomplete pituitary resection more likely. 50% of patients developed at least one pituitary hormone deficiency requiring replacement post-operatively. The risk of post-operative diabetes insipidus or secondary hypothyroidism was minimal.