Adrenal Axis Insufficiency Following Endoscopic Transsphenoidal Resection of Pituitary Adenomas.

Adrenal Axis Insufficiency Following Endoscopic Transsphenoidal Resection of Pituitary Adenomas.

World Neurosurg. 2018 Feb 05;:

Authors: Ajlan A, Almufawez KA, Albakr A, Katznelson L, Harsh GR

Abstract
INTRODUCTION: Hormonal insufficiency of one or more pituitary axes can appear after pituitary surgery. Adrenal axis impairment after surgery can lead to serious consequences if not identified and treated.
OBJECTIVE: Assess early and late post-operative adrenal insufficiency (AI) and identify the risk factors predicting their occurrence after endoscopic transsphenoidal resection of pituitary adenomas.
METHOD: Retrospective review identified 176 pituitary adenomas resected using an endoscopic transsphenoidal approach. Patients on steroids preoperatively, Cushing's disease patients, and patients with incomplete records were excluded. 69 patients were excluded according to our exclusion criteria.
RESULTS: The study group thus included 107 patients (total of 111 operations). The median age was 50 years (range 18-89 years). The median duration of follow up was 30 months (range 6-74 months). 83 (74.7%) had macroadenomas, and 89 (59.3%) had nonfunctional adenomas. Of these 111 procedures, 61 (55%) had early AI. Of the 61 patients, 48 patients (79%) were off steroids in long-term follow-up and only 13 (21%) required long-term replacement. 16/111 (14.4%) had AI on long-term follow-up. Out of these 16 patients, 13 were already on steroids and 3 were newly diagnosed with AI. Age, male gender and cerebrospinal fluid (CSF) leaks were associated with persistent post-operative AI (P=0.018, P=0.001, P=0.007, respectively) CONCLUSION: Hypothalamic pituitary adrenal axis insufficiency is common following endoscopic transsphenoidal surgery. Male gender, age greater than 50 years, visual impairment and intraoperative CSF leak were correlated with late postoperative AI. More than two-thirds of patients who developed early AI did not require steroids long-term.

PMID: 29421453 [PubMed - as supplied by publisher]

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