Skip to main content

Trends in surgery, hospital admissions and imaging for pituitary adenomas in Australia

Endocrine volume 59, pages 373–382 (2018)Cite this article

Abstract

Purpose

There is a paucity of epidemiological information on treatment and imaging of pituitary adenomas in Australia.

Methods

Australian data on pituitary surgery, hospital admissions for pituitary adenomas, and pituitary imaging on patients 15 years and over were obtained from administrative databases between 2000/2001 and 2014/2015. Changes over time and by age and sex were assessed.

Results

In 2014/15 there were 37.7 pituitary procedures/million population, corresponding to a 35.4% (p < 0.05) increase over the 2000/2001 rate. Overall, most (87.2%) procedures were partial excisions of pituitary gland via transsphenoidal surgery (TSS). Admissions for acromegaly increased from 7.1/million in 2000/2001 to 17.2/million in 2003/2004 and then decreased to 6.5/million in 2014/2015. The average age-adjusted rate of pituitary imaging over the study period was 689.6/million/year, which increased significantly (p < 0.05). There was a significant increase in pituitary MRIs (p < 0.05) and a significant decline in pituitary CTs (p < 0.05). Surgical procedure rates were correlated with the pituitary imaging rates (r = 0.62, p < 0.05).

Conclusion

Pituitary surgery rates increased between 2000/2001 and 2014/2015. The most common procedure was partial excision of the pituitary gland via TSS. Admissions for pituitary neoplasms increased over the study while admissions for acromegaly rose to their highest rate in 2003/2004 and then decreased. There was a substantial increase in the rate of pituitary imaging, which may have resulted in increased detection of pituitary incidentalomas. The underlying reasons for the increased rate of pituitary surgery, and the non-sustained increased rate of admissions for acromegaly are unclear and warrant further investigation.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. T.S. Surawicz, B.J. McCarthy, V. Kupelian, P.J. Jukich, J.M. Bruner, F.G. Davis, Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990–1994. Neuro. Oncol. 1(1), 14–25 (1999)

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. A. Tjörnstrand, K. Gunnarsson, M. Evert, E. Holmberg, O. Ragnarsson, T. Rosen, H. Filipsson Nyström, The incidence rate of pituitary adenomas in western Sweden for the period of 2001–2011. Eur. J. Endocrinol. 171(4), 519–526 (2014)

  3. A. Raappaana, J. Koivukangas, T. Ebeling, T. Pirila, Incidence of pituitary adenomas in Northern Finland in 1992–2007. J. Clin. Endocrinol. Metab. 95(9), 4268–4275 (2010)

    Article  Google Scholar 

  4. A.F. Daly, M. Rixhon, C. Adam, A. Dempegioti, M.A. Tichomirowa, A. Beckers, High prevalence of pituitary adenomas: a cross sectional study in the province of Leige, Belgium. J. Clin. Endocrinol. Metab. 91(12), 4769–4775 (2006)

    CAS  Article  PubMed  Google Scholar 

  5. A. Fernandez, N. Karavitaki, J.A. Wass, Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin. Endocrinol. 72(3), 377–382 (2010)

    Article  Google Scholar 

  6. B.M. Arafah, M.P. Nasrallah, Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr. Relat. Cancer. 8, 287–305 (2001)

    CAS  Article  PubMed  Google Scholar 

  7. M.W. Vernooij, M.A. Ikram, H.L. Tanghe, A.J. Vincent, A. Hofman, G.P. Krestin, W.J. Niessen, M.M. Breteler, A. van der Lugt, Incidental findings on brain MRI in the general population. N. Engl. J. Med. 357, 1821–1828 (2007)

    CAS  Article  PubMed  Google Scholar 

  8. S. Naoko, O. Ken’ichi, T. Shigeyuki, T. Akira, K. Yuzuru, A survey of pituitary incidentaloma in Japan. Eur. J. Endocrinol. 149, 123–127 (2003)

    Article  Google Scholar 

  9. S. Berkmann, Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma. Acta Neurochir. 154, 639–647 (2012)

    Article  PubMed  Google Scholar 

  10. P. Famini, M.M. Maya, S. Melmed, Pituitary magnetic resonance imaging for sellar and parasellar masses: ten year experience in 2598 patients. J. Clin. Endocrinol. Metab. 96(6), 1633–1641 (2011)

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. V. Chaudhary, S. Bano, Imaging of the pituitary: Recent advances. Indian J. Endocrinol. Metab. 15(Suppl 3), S216–S223 (2011)

    Article  PubMed  PubMed Central  Google Scholar 

  12. G.U. Mehta, R.R. Lonser: Management of hormone-secreting pituitary adenomas. Neuro. Oncol. (2016). https://doi.org/10.1093/neuonc/now130

  13. M.E. Molitch, Diagnosis and treatment of pituitary adenomas: a review. JAMA. 317(5), 516–524 (2017)

    Article  PubMed  Google Scholar 

  14. M. Buchfelder., S.M. Schlaffer, The surgical treatment of acromegaly. Pituitary. 20(1), 76–83 (2017)

    CAS  Article  PubMed  Google Scholar 

  15. A. Giustina, P. Chanson, D. Kleinberg, M.D. Bronstein, D.R. Clemmons, A. Klibanski, A.K. van der Lely, C.J. Strasburger, S.W. Lamberts, K.K. Ho, F.F. Casanueva, S. Melmed, Expert consensus document: A consensus on the medical treatment of acromegaly. Nat. Rev. Endocrinol. 10(4), 243–248 (2014)

    CAS  Article  PubMed  Google Scholar 

  16. M. Buchfelder, S. Schlaffer, Surgical treatment for pituitary tumours. Best. Pract. Res. Clin. Endocrinol. Metab. 23(5), 677–692 (2009)

    Article  PubMed  Google Scholar 

  17. W.T. Couldwell, Transsphenoidal and transcranial surgery for pituitary adenomas. J. Neurooncol. 69(1–3), 237–256 (2004)

    Article  PubMed  Google Scholar 

  18. M. Ammirati, L. Wei, I. Ciric, Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatr. 84(8), 843–849 (2012)

    Article  Google Scholar 

  19. E. De Divitilis, Endoscopic transphenoidal surgery: stone-in-the-pond effect. Neurosurgery. 59(3), 512–520 (2006)

    Article  Google Scholar 

  20. M.A. Wagenmaker, H.D. Boogaarts, S.H. Roerink, H.J. Timmers, N.M. Stikkelbroeck, J.W. Smit, E.J. van Lindert, R.T. Netea-Maier, J.A. Grotenhuis, A.R. Hermus, Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing’s disease, even in case of macroadenomas or invasive adenomas. Eur. J. Endocrinol. 169(3), 329–337 (2013)

    Article  Google Scholar 

  21. E.A.C. Pereira, P. Plaha, A. Charia, M. Paranathala, N. Haslam, A. Rogers, T. Korevaar, D. Tran, R. Olarinde, N. Karavitaki, A.B. Grossman, S.A. Cudlip, Transsphenoidal pituitary surgery in the elderly is safe and effective. B.J. Neurosurgery. 28(5), 616–621 (2014)

    Article  Google Scholar 

  22. E. Ritvonen, A. Karppinen, H. Sintonen, S. Vehkavaara, L. Kivipelto, R.P. Roine, M. Niemelä, C. Schalin-Jäntti: Normal long-term health-related quality of life can be achieved in patients with functional pituitary adenomas having surgery as primary treatment. Clin. Endocrinol. (2014) https://doi.org/10.1111/cen.12550

  23. L.A. Zimmer, O. Shah, P.V. Theodosopoulus, Short-term quality-of-life changes after endoscopic pituitary surgery rated with SNOT-22. J. Neurol. Surg. B. Skull. Base 75(4), 288–292 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  24. J.A. Villwock, M. Villwock, E. Deshaies, P. Goyal, Significant increases of pituitary tumors and resections from 1993 to 2011. Int. Forum. Allergy. Rhinol. 4, 767–770 (2014)

    Article  PubMed  Google Scholar 

  25. P. Cappabianca, M. Cavallo, A. Colao, E. de Divitiis, Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J. Neurosurg. 97(2), 293–298 (2002)

    Article  PubMed  Google Scholar 

  26. H. Singh, W.I. Essayed, A. Cohen-Gadol, G. Zada, T.H. Schwartz, Resection of pituitary tumours: endoscopic versus microscopic. J. Neurooncol. 130(2), 309–317 (2016)

    Article  PubMed  Google Scholar 

  27. National Centre for Classification in Health (NCCH). The Australian Classification of Health Interventions (ACHI) -Seventh Edition - Tabular list of interventions and Alphabetic index of interventions. (NCCH, Faculty of Health Sciences, The University of Sydney, Sydney), 2010)

    Google Scholar 

  28. Australian Institute of Health and Welfare (AIHW). Admitted patient care 2013–14: Australian hospital statistics. (AIHW, Canberra), 2015). Health services series no. 60. Cat. no. HSE156

    Google Scholar 

  29. Australian Bureau of Statistics. 3101.0 Australian Demographic Statistics. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3101.0. (Accessed Mar 2014)

  30. P.U. Freda, A.M. Beckers, L. Katznelson, M.E. Molitch, V.M. Montori, PostKD., M.L. Vance, Pituitary incidentaloma: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(4), 894–904 (2011)

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. J. Rennet, A. Doerfler, Imaging of sellar and parasellar lesions. Clin. Neurol. Neurosurg. 109, 111–124 (2007)

    Article  Google Scholar 

  32. J. Bevan, Pituitary Incidentaloma. Clin. Med. 13(3), 296–298 (2013)

    Article  Google Scholar 

  33. S. Ezzat, S.L. Asa, W.T. Couldwell, C.E. Barr, W.E. Dodge, M.L. Vance, I.E. McCutcheon, The prevalence of pituitary adenomas: a systematic review. Cancer. 101, 613–619 (2004)

    Article  PubMed  Google Scholar 

  34. N. Karavitaki, K. Collison, J. Halliday, J.V. Byrne, P. Price, S. Cudlip, J.A.H. Wass, What is the natural history of nonoperated nonfunctioning pituitary adenomas? Clin. Endocrinol. 67(6), 938–943 (2007)

    CAS  Article  Google Scholar 

  35. M. Gruppetta, C. Mercieca, J. Vassallo, Prevalence and incidence of pituitary adenomas: a population based study in Malta. Pituitary. 16(4), 545–553 (2013)

    Article  PubMed  Google Scholar 

  36. E. Leifke, V. Gorenoi, C. Wichers, A. Von Zur Muhlen, E. Von Buren, G. Brabant, Age-related changes of serum sex hormones, insulin-like growth factor-1 and sex-hormone binding globulin levels in men: cross-sectional data from a healthy male cohort. Clin. Endocrinol. 53(6), 689–695 (2000)

    CAS  Article  Google Scholar 

  37. A. Giustina, A. Barkan, F.F. Casanueva, F. Cavagnini, L. Frohman, K. Ho, J. Veldhuis, J. Wass, K. Von Werder, S. Melmed, Criteria for cure of acromegaly: a consensus statement. J. Clin. Endocrinol. Metab. 85(2), 526–529 (2000)

    CAS  PubMed  Google Scholar 

  38. M.W. Elmlinger, W. Kühnel, M.M. Weber, M.B. Ranke, Reference ranges for two automated chemiluminescent assays for serum insulin-like growth factor I (IGF-I) and IGF-binding protein 3 (IGFBP-3). Clin. Chem. Lab. Med. 42(6), 654–664 (2004)

    CAS  Article  PubMed  Google Scholar 

  39. A. Algeciras-Schimnich, D.E. Bruns, J.C. Boyd, S.C. Bryant, K.A. La Fortune, S.K. Grebe, Failure of current laboratory protocols to detect lot-to-lot reagent differences: findings and possible solutions. Clin. Chem. 59(8), 1187–1194 (2013)

    CAS  Article  PubMed  Google Scholar 

  40. M.S. Broder, E. Change, D. Cherepanov, M.P. Neary, W.H. Ludlam, Incidence and prevalence of acromegaly in the United States: A Claims-Bsed Analysis. Endocr. Pract. 22(11), 1327–1335 (2016)

    Article  PubMed  Google Scholar 

  41. E. Lesén, D. Granfeldt, A. Houchard, J. Dinet, A. Berthon, D.S. Olsson, I. Björholt, G. Johannsson, Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur. J. Endocrinol. 176(2), 203–212 (2017)

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. School of Medicine, The University of Notre Dame Australia, 60 Oxford St, Darlinghurst, NSW, Australia

    Sjorjina Crowther & R. Louise Rushworth

  2. Division of Chemical Pathology, SA Pathology, Frome Road, Adelaide, SA, Australia

    Wayne Rankin

  3. Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden

    Henrik Falhammar

  4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Henrik Falhammar

  5. Menzies School of Health Research, Royal Darwin Hospital, Darwin, Australia

    Henrik Falhammar

  6. Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia

    Liza K. Phillips & David J. Torpy

  7. Discipline of Medicine, University of Adelaide, Frome Road, Adelaide, SA, Australia

    Liza K. Phillips & David J. Torpy

Authors
  1. Sjorjina Crowther
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Louise Rushworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wayne Rankin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henrik Falhammar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liza K. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David J. Torpy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sjorjina Crowther.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Crowther, S., Rushworth, R.L., Rankin, W. et al. Trends in surgery, hospital admissions and imaging for pituitary adenomas in Australia. Endocrine 59, 373–382 (2018). https://doi.org/10.1007/s12020-017-1457-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-017-1457-4

Keywords

  • Pituitary adenoma
  • Transsphenoidal/transcranial adenomectony
  • Pituitary imaging