Microsurgical therapy of pituitary adenomas

P Mortini, LR Barzaghi, L Albano, P Panni, M Losa

Research output: Contribution to journalArticle

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. © 2017 Springer Science+Business Media, LLC
Original languageEnglish
Pages (from-to)72-81
Number of pages10
JournalEndocrine
Volume59
Issue number1
DOIs
Publication statusPublished - 2018

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Pituitary Neoplasms
Pituitary ACTH Hypersecretion
Adenoma
Therapeutics
Prolactinoma
Adrenal Insufficiency
Hypogonadism
Microsurgery
Hypothyroidism
Hypopituitarism
Diabetes Insipidus
Acromegaly
Morbidity
Safety

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Microsurgical therapy of pituitary adenomas. / Mortini, P; Barzaghi, LR; Albano, L; Panni, P; Losa, M.

In: Endocrine, Vol. 59, No. 1, 2018, p. 72-81.

Research output: Contribution to journalArticle

Mortini, P ; Barzaghi, LR ; Albano, L ; Panni, P ; Losa, M. / Microsurgical therapy of pituitary adenomas. In: Endocrine. 2018 ; Vol. 59, No. 1. pp. 72-81.
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title = "Microsurgical therapy of pituitary adenomas",
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. {\circledC} 2017 Springer Science+Business Media, LLC",
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AU - Albano, L

AU - Panni, P

AU - Losa, M

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N2 - 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. © 2017 Springer Science+Business Media, LLC

AB - 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. © 2017 Springer Science+Business Media, LLC

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DO - 10.1007/s12020-017-1458-3

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