Biochemical remission and recurrence rate of secreting pituitary adenomas after transsphenoidal adenomectomy: long-term endocrinologic follow-up results.
BACKGROUND
Transsphenoidal surgery is safe and effective in patients with secreting pituitary adenomas; however, variable outcomes have been reported according to the different criteria used to define the biochemical remission of hormone hypersecretion. We report the long-term endocrinologic follow-up results of a large cohort of patients who underwent TSS for secreting pituitary adenomas according to the most recent stringent criteria of cure.


METHODS
Two hundred ten consecutive patients were operated on by TSS between 1995 and 2004 for a secreting pituitary adenoma (65 PRL-, 109 GH-, and 36 ACTH-secreting adenomas) and were considered for the study.


RESULTS
The overall remission rate was 65% for the whole series, being 64%, 61%, and 75% for PRL-, GH-, and ACTH-secreting adenomas, respectively. Eighty-six percent of microadenomas and 53% of macroadenomas were cured by surgery. Remission rates were significantly higher in GH- and ACTH-secreting pituitary macroadenomas than in macroprolactinomas. At a median follow-up of 56 months, tumor recurrence was 0%, 11%, and 14% for GH-, ACTH-, and PRL-secreting tumors. Tumor size, cavernous sinus invasion, and high hormone levels were negatively correlated to the outcome.


CONCLUSIONS
Transsphenoidal surgery remains an effective treatment for secreting pituitary tumors according to the most recent criteria of cure. Patients with PRL- or ACTH-secreting adenomas may recur after apparently successful surgery, thereby justifying long-term careful endocrinologic follow-up.
Santoro
Antonio
A
Department of Neurological Sciences, Policlinico Umberto I, University of Rome, La Sapienza, Rome, Italy.
Minniti
Giuseppe
G
Ruggeri
Andrea
A
Esposito
Vincenzo
V
Jaffrain-Rea
Marie-Lise
ML
Delfini
Roberto
R
D000236:Adenoma / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006964:Hyperpituitarism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010908:Pituitary Hormones, Anterior / Q000097:blood / Q000378:metabolism; D010911:Pituitary Neoplasms / Q000097:blood / Q000378:metabolism / Q000601:surgery*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D010908:Pituitary Hormones, Anterior