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Microsurgical therapy of pituitary adenomas

  • Endocrine Surgery
  • Published:
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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.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele University Health Institute, Milan, Italy

    Pietro Mortini, Lina Raffaella Barzaghi, Luigi Albano, Pietro Panni & Marco Losa

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  1. Pietro Mortini
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  2. Lina Raffaella Barzaghi
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  3. Luigi Albano
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Correspondence to Lina Raffaella Barzaghi.

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The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Mortini, P., Barzaghi, L.R., Albano, L. et al. Microsurgical therapy of pituitary adenomas. Endocrine 59, 72–81 (2018). https://doi.org/10.1007/s12020-017-1458-3

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