Endocrine Abstracts

Introduction: Stereotactic radiotherapy and more relevant pharmacotherapy are widely used for PA’s treatment; however transsphenoidal surgery remains gold standard. Postoperative complications and endocrinological outcomes vary widely and are related with surgeon experience and tumor characteristics.

The aim of this study: To determine relationship between pituitary adenoma size and transsphenoidal pituitary adenoma surgery outcomes.

Materials and methods: We performed a retrospective analysis of medical records for patients with pituitary tumor, who underwent transsphenoidal pituitary surgery during 2007–2016 year period at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. Data consisted of 217 patients: 121 (55.76%) male and 96 (44.24%) female, with a mean age of 52.84±15.70 yrs (range 18–84 yrs). Relationship between tumor size, postoperative complications and endocrinological outcomes has been evaluated. The difference between proportions was confirmed using the χ² criterion. The odds ratio was calculated using 2×2 table methodic. Results were interpreted as statistically significant when P<0.05.

Results: The study included 123 nonfunctioning and 94 functioning adenomas: 38 were prolactinomas, 12 growth hormone (GH) and four corticotropin (ACTH) secreting adenomas. The majority of tumors 174 (80.18%) were macro adenomas (>1 cm), 26 (11.99%) micro adenomas (<1 cm) and 18 (8.29%) giant adenomas (>4 cm). The most common presenting symptoms were visual disturbance 117 (53.91%) and headache 122 (56.22%). Possibility for visual disturbance before surgery was significantly higher in macro adenomas group (OR 1.89 (±95 CI 1.66–2.17); P=0.038). Hypopituitarism prior operation was reported for 7 (3.22%) patients, all presented with nonfunctioning macro adenomas. Postoperative complications were observed in 31 (14.28%) patients. We confirmed that after surgery in patients with macro adenomas visual field (VF) and visual acuity (VA) improvement chance was significantly higher (VF OR 2.28 (±95 CI 1.12–1.46); P=0.03), (VA OR 2.15 (±95 CI 1.89–2.46); P=0.03). Odds to have the same VF and VA parameters after micro adenomas surgery were the following: VF OR 1.28 (±95 CI 1.13–1.47); P=0.03), VA OR 2.40 (±95 CI 2.1–2.74); P=0.03. After surgery remission achieved for 81 (37.32%) patients. Hypopituitarism was observed in 21 (8.42) patients and risk was significantly higher after macro adenomas surgery (OR 1.25 (±95 CI 1.1–1.44); P=0.05).

Conclusions: Our study demonstrated significant improvement of VF and VA, but higher risk for postoperative hypopituitarism after pituitary macro adenomas trassphenoidal surgery.