Endocrine Abstracts

Aim: To study the results of transsphenoidal surgery in our Neuroendocrinology Unit in last 10 years.

Methods: We reviewed all patients operated in our hospital and followed in our Neuroendocrinology Unit in the last 10 years. We excluded patients with previous surgery or irradiation on this area. We obtained data about type and size of tumor, previous hormonal deficit, local symptoms,complications of surgery and the status after this (remission, persistence or recurrence).

Results: One hundred and six patients, mean age 46.2±16.1 years, 42.4% women. Diagnosis:non-functioning adenomas :57.2%, acromegaly: 23, 6% and others 19.2%. The size: 92.5% macroadenomas. Prior to surgery, 16% had hyperprolactinemia, 22.6% TSH deficiency, 22.6% FSH/LH deficiency, 15.1% ACTH deficiency and 11.6% GH deficiency. Local symptoms (62%): the most frequent symptom was visual disturbance (43.4%) followed by headache (39.6%) and cranial nerve impairment (2.8%). Early complications were: 17.4% diabetes insipidus, 5.4% cerebrospinal fluid fistula, 6.5% both simultaneously, one case of obstructive hydrocephalus and one case of intratumoral bleeding. Late complications: two patients diabetes insipidus, two cerebrospinal fluid fistula and two patients both. 48.9% had postoperative hormone deficiency: FSH/LH deficiency 37%,TSH 37%,ACTH 35.9% and GH deficiency 27.4%. There was local symptoms improvement in 54.4% of patients.After surgery,tumor mass remained in 46.7% (100% of prolactinomas, 50.8% of non-functioning and 48% of acromegaly), 6.5% recurred and 29.3% are in remission (the rest are in postoperative evaluation period). After the first surgery, 16.9% required further medical treatment, 17% were reoperated and 33.7% received radiotherapy. Age over 40 years was associated with an increased likelihood of remnant mass (P=0.03) regardless of tumor size. The presence of ACTH deficiency before surgery was significantly associated with the possibility of hormonal deficit after surgery (P=0.00) and possibility of remnant mass (P=0.05) The presence of local clinic was related to the appearance of early complications after surgery (P=0.007).

Conclusions: After transsphenoidal surgery, there is a low incidence of local complications but high incidence of postoperative hormonal deficits (as described in other literature). Age over 40 years, preoperative ACTH deficiency and the presence of local symptoms are related to worse outcomes after surgery.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.