Endocrine

, Volume 59, Issue 1, pp 72–81 | Cite as

Microsurgical therapy of pituitary adenomas

  • Pietro Mortini
  • Lina Raffaella Barzaghi
  • Luigi Albano
  • Pietro Panni
  • Marco Losa
Endocrine Surgery

Abstract

Purpose

We report the efficacy and safety of transsphenoidal microsurgery in a large and homogeneous cohort of patients with pituitary adenomas (PAs) treated at a single Institute by a single neurosurgeon.

Methods

A total of 2145 consecutive patients undergoing first surgery for a PA were included: 795 (37.1%) had a nonfunctioning pituitary adenoma (NFPA), 595 (27.7%) acromegaly, 496 (23.1%) Cushing’s disease, 208 (9.7%) a PRL-secreting adenoma, and 51 patients (2.4%) a TSH-secreting adenoma. Remission was achieved when strict hormonal and radiological criteria were met.

Results

Early surgical remission was achieved in 66% of acromegalic patients, 79.6% of patients with Cushing’s disease, 64.4% of prolactinomas, 74.5% of patients with a TSH-secreting adenoma, and 66.9% of NFPAs. The mean (±SE) follow-up was 60.1 ± 1.3 months. The recurrence-free survival at 10 years was 78.2% in acromegalic patients, 68.1% in prolactinomas, 74.3% in Cushing’s disease, 70.3% in TSH-secreting adenomas, and 75.3% in NFPAs. Preoperative hypoadrenalism recovered in 35.3%, hypogonadism in 43.3% and hypothyroidism in 37.4% of patients with impaired function before surgery. The mortality rate was 0.2% and major morbidity 2.1%. New onset hypoadrenalism occurred after surgery in 2.5% of patients at risk, hypogonadism in 4.1%, and hypothyroidism in 1.8%. Permanent diabetes insipidus (DI) occurred in 0.9% of patients.

Conclusions

In experienced hands, transsphenoidal microsurgery for PAs achieves remission in most patients with a low complication rate. Pituitary function is preserved in most cases and can recover in more than one-third of patients with preoperative hypopituitarism.

Keywords

Pituitary adenomas Transsphenoidal surgery Surgical results Surgical complications. 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Pietro Mortini
    • 1
  • Lina Raffaella Barzaghi
    • 1
  • Luigi Albano
    • 1
  • Pietro Panni
    • 1
  • Marco Losa
    • 1
  1. 1.Department of Neurosurgery and Gamma Knife RadiosurgerySan Raffaele University Health InstituteMilanItaly

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