Author(s): Nomikos P, Ladar C, Fahlbusch R, Buchfelder M
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Abstract INTRODUCTION: The aim of this study was to define the impact of surgery on pituitary function in a large consecutive series of patients harbouring non-functioning pituitary adenomas. MATERIALS AND METHOD: Between December 1982 and December 2000, a total of 822 patients underwent primary surgery in the authors' department. In 721 cases a complete set of endocrinological data was available. Functions of the pituitary-gonadal, pituitary-thyroid and pituitary-adrenal axes were assessed immediately before surgery and again one week, 3 months and 1 year after the operation, utilizing standardized tests and commercially available assays. RESULTS: There was some degree of pre-operative hypopituitarism in 561 (85\%) and 53 (86.3\%) of the patients belonging to the transsphenoidal and the transcranial groups, respectively. Prior to transsphenoidal [transcranial] surgery, 163 (31\%) [34 (55.7\%)] of the patients had secondary adrenal deficiency, 463 (76.6\%) [49 (89\%)] had hypogonadism and 105 (19.1\%) [14 (25.4\%)] were hypothyroid. Preoperatively, prolactin levels were mildly elevated in 167 patients (25.3\%), whereas 1 year after surgery, levels were elevated in only 5 patients. Permanent diabetes insipidus occurred in 4 patients, 2 from the transsphenoidal group (0.3\%) and 2 from the transcranial group (3.2\%). Following transsphenoidal surgery 110 (19.6\%) of patients had normal pituitary function [versus 0\% after transcranial surgery], 169 (30.1\%) [6 (11.3\%)] showed improvement, 274 (48.9\%) [49 (73.7\%)] had persistent deficits and 8 (1.4\%) [8 (15\%)] showed deterioration of pituitary function. DISCUSSION: These data indicate that transsphenoidal surgery for non-functioning pituitary adenomas in expert hands is, relatively, far less detrimental to patients compared with transcranial surgery. The latter carries a much greater risk of post-operative deterioration in pituitary function.
This article was published in Acta Neurochir (Wien)
and referenced in Journal of Steroids & Hormonal Science