Kihwan Hwang, Yong Hwy Kim, Jung Hee Kim, Jung Hyun Lee, Hee Kyung Yang, Jeong-Min Hwang, Chae-Yong Kim and Jung Ho Han
The authors investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) with optic nerve compression.
This study retrospectively analyzed the natural history of asymptomatic NFPAs with documented optic nerve compression on MRI diagnosed between 2000 and 2016 from 2 institutions. The patients were followed up with regular endocrinological, ophthalmological, and radiological evaluations, and the endpoint was new endocrinopathy or neurological deficits.
The study comprised 81 patients. The median age at diagnosis was 58.0 years and the follow-up duration was 60.0 months. As the denominator of overall pituitary patients, 2604 patients were treated with surgery after diagnosis at the 2 institutions during the same period. The mean initial and last measured values for tumor diameter were 23.7 ± 8.9 mm and 26.2 ± 11.4 mm, respectively (mean ± SD). Tumor growth was observed in 51 (63.0%) patients; however, visual deterioration was observed in 14 (17.3%) patients. Ten (12.3%) patients experienced endocrine deterioration. Fourteen (17.3%) patients underwent surgery for either visual deterioration (in 12 patients) or endocrine dysfunction (in 2 patients). After surgery, all patients experienced improvements in visual or hormonal function. The actuarial rates of treatment-free survival at 2, 3, and 5 years were 96.1%, 93.2%, and 85.6%, respectively. In the multivariate analysis, initial cavernous sinus invasion (HR 4.985, 95% CI 1.597–15.56; p = 0.006) was the only independent risk factor for eventual treatment.
The neuroendocrinological deteriorations were not frequent and could be recovered by surgery with early detection on regular follow-up in asymptomatic NFPAs with documented optic nerve compression on MRI. Therefore, conservative management could be an acceptable strategy for these tumors. Careful follow-up is required for tumors with cavernous sinus invasion.
Nam Ik Cho, Chang Ju Hwang, Ho Yeon Kim, Jong-Min Baik, Youn Suk Joo, Choon Sung Lee, Mi Young Lee, So Jeong Yoon and Dong-Ho Lee
The need for scoliosis screening remains controversial. Nationwide school screening for scoliosis has not been performed in South Korea, and there are few studies on the referral patterns of patients suspected of having scoliosis. This study aimed to examine the referral patterns to the largest scoliosis center in South Korea in the absence of a school screening program and to analyze the factors that influence the appropriateness of referral.
The medical records of patients who visited a single scoliosis center for a spinal deformity evaluation were reviewed. Among 1895 new patients who visited this scoliosis center between April 2014 and March 2016, 1211 with presumed adolescent idiopathic scoliosis were included in the study. Patients were classified into 4 groups according to the referral method: non–health care provider, primary physician, hospital specialist, or school screening program. The appropriateness of referral was labeled as inappropriate, late, or appropriate. In total, 213 of 1211 patients were excluded because they had received treatment at another medical facility; 998 patients were evaluated to determine the appropriateness of referral.
Of the 998 referrals of new patients with presumed adolescent idiopathic scoliosis, 162 (16.2%) were classified as an inappropriate referral, 272 (27.3%) were classified as a late referral, and 564 (56.5%) were classified as an appropriate referral. Age, sex, Cobb angle of the major curve, and skeletal maturity were identified as statistically significant factors that correlated with the appropriateness of referral. The referral method did not correlate with the appropriateness of referral.
Under the current health care system in South Korea, a substantial number of patients with presumed adolescent idiopathic scoliosis are referred either late or inappropriately to a tertiary medical center. Although patients referred by school screening programs had a significantly lower late referral rate and higher appropriate referral rate than the other 3 groups, the referral method was not a significant factor in terms of the appropriateness of referral.