PNA Medical Corner: Recovery After Transsphenoidal Surgery
This month’s PNA Medical Corner focuses on an article co-written by several members of the PNA: Drs. Little, Gardner, Fernandez-Miranda, Barkhoudarian, Prevedello, Yuen and Kelly. The study looked at measures of recovery of the pituitary gland after fully endoscopic transsphenoidal surgery and found improvement only in a substantial minority of patients, especially those with adrenal insufficiency.
J Neurosurg. 2019 Nov 15:1-7. doi: 10.3171/2019.8.JNS191012. [Epub ahead of print]
Pituitary gland recovery following fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenoma: results of a prospective multicenter study.
Little AS1, Gardner PA2, Fernandez-Miranda JC3, Chicoine MR4, Barkhoudarian G5, Prevedello DM6, Yuen KCJ7, Kelly DF5; TRANSSPHER Study Group.
1Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
2Department of Neurosurgery, University of Pittsburgh, Pennsylvania.
3 Department of Neurosurgery, Stanford University, Palo Alto, California.
4Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
5Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California.
6Department of Neurological Surgery, The Ohio State University, Columbus, Ohio; and.
7Department of Neuroendocrinology, Barrow Neurological Institute, Phoenix, Arizona.
Recovery from preexisting hypopituitarism after transsphenoidal surgery for pituitary adenoma is an important outcome to investigate. Furthermore, pituitary function has not been thoroughly evaluated after fully endoscopic surgery, and benchmark outcomes have not been clearly established. Here, the authors characterize pituitary gland outcomes with a focus on gland recovery following endoscopic transsphenoidal removal of clinically nonfunctioning adenomas.
This multicenter prospective study was conducted at 6 US pituitary centers among adult patients with nonfunctioning pituitary macroadenomas who had undergone endoscopic endonasal pituitary surgery. Pituitary gland function was evaluated 6 months after surgery.
The 177 enrolled patients underwent fully endoscopic transsphenoidal surgery; 169 (95.5%) of them were available for follow-up. Ninety-five (56.2%) of the 169 patients had had a preoperative deficiency in at least one hormone axis, and 20/95 (21.1%) experienced recovery in at least one axis at the 6-month follow-up. Patients with adrenal insufficiency were more likely to recover (10/34 [29.4%]) than were those with hypothyroidism (8/72 [11.1%]) or male hypogonadism (5/50 [10.0%]). At the 6-month follow-up, 14/145 (9.7%) patients had developed at least one new deficiency. The study did not identify any predictors of gland recovery (p ≥ 0.20). Permanent diabetes insipidus was observed in 4/166 (2.4%) patients. Predictors of new gland dysfunction included a larger tumor size (p = 0.009) and Knosp grade 3 and 4 (p = 0.051).
Fully endoscopic pituitary surgery resulted in improvement of pituitary gland function in a substantial minority of patients. The deficiency from which patients were most likely to recover was adrenal insufficiency. Overall rates of postoperative permanent diabetes insipidus were low. This study provides multicenter benchmark neuroendocrine clinical outcome data for the endoscopic technique.
GTR = gross-total resection; STR = subtotal resection; endoscopic surgery; hypopituitarism; nonfunctioning adenoma; pituitary surgery; transsphenoidal surgery