Izvorni znanstveni članak
Endocrinological outcomes of pure endoscopic transsphenoidal surgery: a Croatian Referral Pituitary Center experience
Andreja Marić
; Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Ivan Kruljac
; Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Vatroslav Čerina
; Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Hrvoje Ivan Pećina
; Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Petra Šulentić
; Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Milan Vrkljan
; Referral Center for Clinical Neuroendocrinology and Pituitary Diseases, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Sažetak
Aim To analyze early remission, complications, and pituitary
function recovery after pure endoscopic endonasal
transsphenoidal surgery (PEETS), a novel method in pituitary
adenoma treatment.
Methods Testing of all basal hormone values and magnetic
resonance imaging (MRI) were performed preoperatively
and postoperatively (postoperative MRI only in nonfunctioning
adenomas) in 117 consecutive patients who underwent
PEETS in the period between 2007 and 2010. The series consisted
of 21 somatotroph adenomas, 61 prolactinomas, and 4
corticotroph and 31 nonfunctioning adenomas. Sixty-three
were macroadenomas and 54 were microadenomas. Remission
was defined as hormonal excess normalization on the
seventh postoperative day in functioning adenomas and as
normal MRI findings approximately four months postoperatively
in nonfunctioning adenomas. The presence of hypogonadism,
growth hormone deficiency, and hypothyroidism
was assessed on the seventh postoperative day. Hypocortisolism
was assessed through necessity for replacement
therapy within 18 months postoperatively.
Results Remission was achieved in 84% of patients: in 100%
of microadenoma and 70% of macroadenoma patients
(P < 0.001, odds ratio [OR], 28.16, 95% confidence interval
[CI], 1.61-491.36), respectively. Endocrinological complications
occurred in 17.1% of patients: in 9% of microadenoma
and 24% of macroadenoma patients (P = 0.049, OR, 3.06;
95% CI, 1.03-9.08). Duration of empirical hydrocortisone replacement
therapy was significantly shorter in microadenoma
patients (P < 0.001). Thirty-five percent of preoperatively
present hormonal deficiencies improved after the surgery.
Between tumor types there were no significant differences
in remission, complications, and normal pituitary function
recovery.
Conclusion Patients with microadenomas had higher remission
and lower complication rates following PEETS, emphasizing
the necessity for early detection and treatment
of pituitary adenomas. PEETS is a discussion-worthy method
for microprolactinoma treatment.
Ključne riječi
Hrčak ID:
84157
URI
Datum izdavanja:
15.6.2012.
Posjeta: 1.418 *