The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas.
From 1962 to 1987, 126 patients underwent trans-sphenoidal surgery for primary treatment of pituitary adenomas unassociated with clinical or biochemical evidence of hormonal overproduction. There were 73 male and 53 female patients (mean age, 50 +/- 12 years). Before surgery, 56% of the patients (70 of 124) had headaches, 74% (94 of 126) had deterioration of vision, and 12% (15 of 126) had ophthalmoplegia. Endocrine evaluation revealed the presence of hypogonadism in 75% (87 of 115), adrenal insufficiency in 36% (46 of 126), and hypothyroidism in 18% (21 of 122). Plasma prolactin was increased in 65% (56 of 86) with a mean level of 39 +/- 14 micrograms/l (normal, 3 to 20 micrograms/l). Radiologic enlargement of the sella turcica was documented in all cases: 67% (84 of 126) had enclosed and 33% (42 of 126) had invasive adenomas. After surgery, vision was normalized or improved in 75% (71 of 94) of the patients. Thyroid, adrenal, and gonadal functions were improved in 14% (three of 22), 41% (19 of 46), 11% (ten of 87), were unchanged in 82% (100 of 122), 77% (97 of 126), 89% (102 of 115), and worsened in 15% (19 of 22), 8% (ten of 126), 3% (102 of 115), respectively. Permanent diabetes insipidus occurred in 5% (seven of 126). Two patients died during the immediate postoperative period. The recurrence rate in patients with a mean follow-up of 6.4 +/- 4.2 years was 21% (15 of 71). These data indicate that trans-sphenoidal microsurgery is an effective and safe initial treatment for patients with nonsecreting pituitary adenoma and may reverse hypopituitarism.
Comtois
R
R
Department of Medicine, Notre-Dame Hospital, University of Montréal, Canada.
Beauregard
H
H
Somma
M
M
Serri
O
O
Aris-Jilwan
N
N
Hardy
J
J
D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000209:etiology; D000328:Adult; D000368:Aged; D002648:Child; D004700:Endocrine System Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007006:Hypogonadism / Q000209:etiology; D007037:Hypothyroidism / Q000209:etiology; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D013100:Sphenoid Bone; D014786:Vision Disorders / Q000209:etiology