Prognostic factors for outcome after transsphenoidal hypophysectomy in dogs with pituitary-dependent hyperadrenocorticism

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Object

The aim of this study was to determine prognostic factors for outcome after transsphenoidal hypophysectomy in dogs with pituitary-dependent hyperadrenocorticism (PDH).

Methods

One veterinary neurosurgeon performed transsphenoidal hypophysectomies in 181 dogs with PDH over a 12-year period. Survival analysis was performed with the Kaplan–Meier method. Prognostic factors were analyzed with the univariate Cox proportional hazard analysis followed by stepwise multivariate analysis. The log-rank test was used to assess disease-free fractions in three groups categorized according to early postoperative urinary corticoid/creatinine (C/C) ratios.

Results

Multivariate analysis revealed that old age, large pituitary size, and high preoperative concentrations of plasma adrenocorticotropic hormone were associated with an increased risk of PDH-related death. In addition, large pituitary size, thick sphenoid bone, high C/C ratio, and high concentration of plasma α-melanocyte–stimulating hormone (α-MSH) before surgery were associated with an increased risk of disease recurrence in the dogs that went into remission after hypophysectomy. Disease-free fractions were significantly higher in dogs with postoperative urinary C/C ratios in the lower normal range (< 5 × 10−6) than in dogs with postoperative C/C ratios in the upper normal range (5–10 × 10−6).

Conclusions

The results of this study indicate that pituitary size, sphenoid bone thickness, plasma α-MSH concentration, and preoperative level of urinary cortisol excretion are predictors of long-term remission after transsphenoidal hypophysectomy for PDH in dogs. Urinary C/C ratios measured 6 to 10 weeks after surgery can be used as a guide for predicting the risk of tumor recurrence.

Abbreviations used in this paper:ACTH = adrenocorticotropic hormone; α-MSH = α-melanocyte–stimulating hormone; C/C = corticoid/creatine; CI = confidence interval; CT = computed tomography; CV = coefficient of variation; IRMA = immunoradiometric assay; MR = magnetic resonance; P/B = pituitary height/brain area; PDH = pituitary-dependent hyperadrenocorticism.
Article Information

Contributor Notes

Address correspondence to: Jeanette Hanson, D.V.M., Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80.154, NL-3508 TD Utrecht, The Netherlands. email: j.m.hanson@uu.nl.
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