Pituitary gland recovery following fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenoma: results of a prospective multicenter study

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OBJECTIVE

Recovery from preexisting hypopituitarism after transsphenoidal surgery for pituitary adenoma is an important outcome to investigate. Furthermore, pituitary function has not been thoroughly evaluated after fully endoscopic surgery, and benchmark outcomes have not been clearly established. Here, the authors characterize pituitary gland outcomes with a focus on gland recovery following endoscopic transsphenoidal removal of clinically nonfunctioning adenomas.

METHODS

This multicenter prospective study was conducted at 6 US pituitary centers among adult patients with nonfunctioning pituitary macroadenomas who had undergone endoscopic endonasal pituitary surgery. Pituitary gland function was evaluated 6 months after surgery.

RESULTS

The 177 enrolled patients underwent fully endoscopic transsphenoidal surgery; 169 (95.5%) of them were available for follow-up. Ninety-five (56.2%) of the 169 patients had had a preoperative deficiency in at least one hormone axis, and 20/95 (21.1%) experienced recovery in at least one axis at the 6-month follow-up. Patients with adrenal insufficiency were more likely to recover (10/34 [29.4%]) than were those with hypothyroidism (8/72 [11.1%]) or male hypogonadism (5/50 [10.0%]). At the 6-month follow-up, 14/145 (9.7%) patients had developed at least one new deficiency. The study did not identify any predictors of gland recovery (p ≥ 0.20). Permanent diabetes insipidus was observed in 4/166 (2.4%) patients. Predictors of new gland dysfunction included a larger tumor size (p = 0.009) and Knosp grade 3 and 4 (p = 0.051).

CONCLUSIONS

Fully endoscopic pituitary surgery resulted in improvement of pituitary gland function in a substantial minority of patients. The deficiency from which patients were most likely to recover was adrenal insufficiency. Overall rates of postoperative permanent diabetes insipidus were low. This study provides multicenter benchmark neuroendocrine clinical outcome data for the endoscopic technique.

ABBREVIATIONS GTR = gross-total resection; STR = subtotal resection.
Article Information

Contributor Notes

Correspondence Andrew S. Little: c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ. neuropub@barrowneuro.org.INCLUDE WHEN CITING Published online November 15, 2019; DOI: 10.3171/2019.8.JNS191012.Disclosures Dr. Little is a stockholder in Kogent Surgical, LLC, and has stock options in SPIWay, LLC. Dr. Kelly receives royalties from Mizuho America, Inc. Dr. Chicoine has received unrestricted grant funding from IMRIS, Inc. Dr. Barkhoudarian has received consulting fees from Vascular Technologies, Inc. Dr. Gardner is a stockholder in SPIWay, LLC. Dr. Prevedello is a consultant for Stryker Corp., Medtronic, plc, and Codman Neuro and receives royalties from KLS Martin, LP. Dr. Yuen is a consultant for Pfizer, Novo Nordisk, Sandoz, Aeterna Zentaris, Novartis, Corcept Therapeutics, and Strongbridge Biopharma Co. This study was supported by the Center for Cranial Base Surgery, University of Pittsburgh, Pennsylvania.
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