TY - JOUR
T1 - Pituitary gland recovery following fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenoma
T2 - Results of a prospective multicenter study
AU - Little, Andrew S.
AU - Gardner, Paul A.
AU - Fernandez-Miranda, Juan C.
AU - Chicoine, Michael R.
AU - Barkhoudarian, Garni
AU - Prevedello, Daniel M.
AU - Yuen, Kevin C.J.
AU - Kelly, Daniel F.
N1 - Funding Information:
Dr. Chicoine has received clinical or research support from Head for the Cure and the Carol A. Rossfield–Alex & Alice Aboussie Charitable Foundation. This study was also supported by Barrow Neurological Foundation, Phoenix, Arizona.
Funding Information:
Dr. Little is a stockholder in Kogent Surgical, LLC, and has stock options in SPIWay, LLC. Dr. Kelly receives royalties from Mizuho America, Inc. Dr. Chicoine has received unrestricted grant funding from IMRIS, Inc. Dr. Barkhoudarian has received consulting fees from Vascular Technologies, Inc. Dr. Gardner is a stockholder in SPIWay, LLC. Dr. Prevedello is a consultant for Stryker Corp., Medtronic, plc, and Codman Neuro and receives royalties from KLS Martin, LP. Dr. Yuen is a consultant for Pfizer, Novo Nordisk, Sandoz, Aeterna Zentaris, Novartis, Corcept Therapeutics, and Strongbridge Biopharma Co. This study was supported by the Center for Cranial Base Surgery, University of Pittsburgh, Pennsylvania.
Publisher Copyright:
© AANS 2020.
PY - 2020/12
Y1 - 2020/12
N2 - OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
AB - OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
KW - Endoscopic surgery
KW - Hypopituitarism
KW - Nonfunctioning adenoma
KW - Pituitary surgery
KW - Transsphenoidal surgery
UR - https://www.scopus.com/pages/publications/85097171654
U2 - 10.3171/2019.8.JNS191012
DO - 10.3171/2019.8.JNS191012
M3 - Review article
C2 - 31731279
AN - SCOPUS:85097171654
SN - 0022-3085
VL - 133
SP - 1732
EP - 1738
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 6
ER -