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Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function
Subramanian, V Lee, Rachel Su-Min Howell, Simon Gregson, Samuel Lahart, Ian Kaushal, Kalpana Pappachan, JM
Subramanian, V
Lee, Rachel Su-Min
Howell, Simon
Gregson, Samuel
Lahart, Ian
Kaushal, Kalpana
Pappachan, JM
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2021-04-06
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Abstract
Background: Non-functioning pituitary macroadenomas (NFPAs) with visual field defects are ideally managed by transsphenoidal tumour resection to improve vision, and long-term postsurgical follow up is necessary to monitor for tumour recurrence. Regular updates from global data are necessary for developing optimal management strategies of these tumours. Methods: Pre- and postoperative visual and endocrine profile, imaging characteristics and details of surgical interventions among patients with NFPAs managed between 2008 and 2019 in a UK regional centre were assessed. The radiological and surgical outcomes including postoperative complications, recurrence risk and the factors influencing outcomes also were assessed. Results: 105 cases with mean (SD) age 60.1 (14.3) years and follow-up duration 60 (37) months were studied. 67 (64%) patients were male. Five-year recurrence-free survival rate was 71.5% (95% confidence interval [CI] 62.7% to 81.6%) with 33 (31%) tumour recurrences of whom 20 (60%) received radiotherapy and 9 (27%) underwent further surgery. Younger age, tumour volume, and bilateral cavernous sinus extension were the predictors of recurrence on univariate analysis, while younger age was the only factor on multivariate analysis (Hazard ratio 0.95; 95% CI: 0.92, 0.97). 72/78 patients (92%) with preoperative visual field defects improved after surgery, of whom 27 (35%) had full recovery. 20 (24%) patients had recovery of an abnormal hormone axis. 15 patients (16%) developed perioperative complications such as cerebrospinal fluid leak (12 cases), meningitis (2 cases), and bleeding (2 cases). Conclusions: Five-year recurrence-free survival after transsphenoidal resection for NFPAs was 71.5% with older age at surgery conferring lower risk of recurrence. Visual recovery/ improvement occurred in 92% of cases with preoperative visual defects following surgery.
Citation
Subramanian, V., Lee, R.S.M., Howell, S. et al. (2021) Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function. Endocrine 73, pp. 407–415. https://doi.org/10.1007/s12020-021-02713-1
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PubMed ID
33822319 (pubmed)
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Journal article
Language
en
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This is an accepted manuscript of a paper published by Springer on 06/04/2021, available online: https://doi.org/10.1007/s12020-021-02713-1 The accepted manuscript of the publication may differ from the final published version. For re-use please see the publisher's terms and conditions.
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ISSN
1355-008X
EISSN
1559-0100