Endocrine Abstracts

BACKGROUND: An audit of facilities and medical and surgical care based on the 1997 Royal College of Physicians and Society for Endocrinology guidelines for the management of pituitary tumours was carried out in the South West in 2001. We present the results for patients referred to one specialist pituitary surgeon in Plymouth.
METHODS: 1. A questionnaire was sent to each endocrinology department covering staff resources, facilities for investigations and the process of care. 2. A retrospective case notes review was performed for all patients undergoing pituitary surgery between 1995 and 2000. The National Pituitary Database was used for analysis.
RESULTS: All hospitals have at least one consultant endocrinologist and appropriate facilities for investigation of pituitary patients. Half do not have a multidisciplinary clinic and a minority have an endocrine nurse specialist. 104 patients were identified. 60% had non-functioning adenoma (NFA) and 40% had functioning adenoma (FA). Documentation of pre- and post-operative endocrine and visual assessment was generally poor. For only 61% patients was the result of preoperative prolactin found. Those with a NFA were more likely than FA to have pre-operative visual field assessment (85% vs. 21%, chi-square=42.7 p<0.0001) but less likely to have pituitary function testing (56% vs. 83%, chi-square=9.3 p=0.002), reflecting referring specialty. Recording of postoperative visual field assessment and post-operative pituitary function testing was incomplete in 10-30% patients. Surgical complication rates were low. Results of surgery with regard to visual and endocrine outcomes were good. 66% of patients with acromegaly and 100% of patients with Cushing's disease were cured.
CONCLUSIONS: All referring hospitals had adequate facilities and surgical care was good. However inadequacies were identified in documentation and clinical evaluation of patients. The investigation and management of patients with pituitary tumours should be undertaken in multidisciplinary teams using standardised documentation. All patients should be referred to an endocrinologist prior to surgery.