ECE2021 Audio Eposter Presentations Pituitary and Neuroendocrinology (113 abstracts)
University Clinical Hospital of Santiago de Compostela, Division of Endocrinology and Nutrition., Spain
Objectives
To present the results of our series of endoscopic surgery of PA, performed in a third level hospital by an experienced team.
Methods
Retrospective review of PA undergoing endoscopic surgery between 2011 2018 in our institution. Clinical variables and radiological characteristics and outcomes were collected at diagnosis, before surgery and for an average of 4.8 years of postoperative follow-up.
Results
121 patients with PA and endoscopic surgery were identified. Table 1 summarises baseline characteristics.
Age at surgery (years) | 57.8 ± 17 |
Sex (n male) | 64 (52.9%) |
Charlson Index score | 2 (0-10) |
Clinical presentation (at diagnosis) - Incidental - Hypopituitarism - Apoplexy - Compressive symptoms - Visual impairment |
43 (35.5%) 65 (53.7%) 13 (10.7%) 51 (42.1%) 38 (31.4%) |
Non-functioning adenoma Functioning adenoma - GH-secreting - ACTH-secreting - PRL-secreting - TSH-secreting |
78 (35.5%) 43 (64.5%) 26 (21.4%) 11 (9.0%) 5 (4.1%) 1 (0.8%) |
Tumour characteristics - Tumour size - Macroadenoma - Maximum diameter (mm) - Extrasellar extension - Suprasellar - Sphenoidal - Cavernous sinus invasion - Knosp >3 |
102 (84.3%) 22.3 ± 11.0 92 (76.0%) 86 (71.1%) 20 (16.5%) 47 (38.8%) 28 (23.1%) |
Data are n (%) values, mean ± SD or median (IQR).
Surgical evolution and post-surgical outcomes are shown in Table 2.
Surgery indications - Functioning adenoma - Compressive symptoms - Large tumour size - Apoplexy - Resistance to medical treatment |
41 (33.9%) 40 (33.1%) 30 (24.8%) 8 (6.3%) 2 (1.6%) |
Complications: Intraoperative - CSF leak - Intracranial haemorrhage - Epistaxis Immediate postoperative (1st week after surgery) - DI - Infection - Epistaxis - CSF leak - Other Late postoperative - DI - Infection - CSF leak - Other |
4 (3.3%) 1 (0.8%) 2 (1.6%) 1 (0.8%) 35 (28.9%) 13 (10.7%) 5 (4.1%) 4 (2.8%) 3 (3.3%) 10 (8.2%) 16 (13.2%) 7 (5.7%) 2 (1.6%) 1 (0.8%) 6 (4.9%) |
Hospital stay (days) | 7.3 ± 6.0 |
Postoperative status - Visual field improvement - Hormone excess normalization - Hypopituitarism - Macroscopic total resection - Absence of tumor rest (RM/TC) |
25/38 (65, 7%) 22/43 (51, 1%) 65 (53, 7%) 86 (71, 1%) 82 (67, 8%) |
Final visit outcomes - Reintervention - Radiotherapy - Remission - Death |
19 (15.7%) 14 (11.5%) 76 (62.8%) 3 (2.5%) |
Conclusion
Endoscopic pituitary surgery appears to be safe and effective when an experienced pituitary team is available.