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Vol. 33. Issue 6.
Pages 300-309 (November - December 2022)
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Vol. 33. Issue 6.
Pages 300-309 (November - December 2022)
Clinical Research
Endoscopic endonasal approach to pituitary adenomas: Impact on adenohypophyseal function. Study of 231 cases
Abordaje endoscópico endonasal en adenomas hipofisarios: impacto en la función adenohipofisaria. Estudio de 231 casos
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Marta Araujo-Castroa,
Corresponding author
martaazul.2a@hotmail.com

Corresponding author.
, Franklin Mariño-Sánchezb, Alfredo García Fernándezc, Alberto Acitores Cancelad, Víctor Rodríguez Berrocald,e
a Hospital Universitario Ramón y Cajal, Department of Endocrinology & Nutrition, Neuroendocrinology Unit, and Instituto Ramón & Cajal de Investigación Biomédica (IRYCIS), Madrid, Spain
b Hospital Universitario Ramón y Cajal, Otorhinolaryngology Department, Rhinology and Skull Base Surgery Unit, Madrid, Spain
c Hospital HM Puerta del Sur, Otorhinolaryngology Department, Rhinology and Skull Base Surgery Unit, Madrid, Spain
d Hospital Universitario Ramón y Cajal, Department of Neurosurgery, Pituitary Surgery Unit, Madrid, Spain
e Hospital HM Puerta del Sur, Department of Neurosurgery, Pituitary Surgery Unit, Madrid, Spain
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Abstract
Purpose

To identify presurgical and surgical factors associated with the development of hypopituitarism and its recovery after endoscopic endonasal transsphenoidal (EET) resection of pituitary adenomas (PAs).

Methods

Retrospective study of patients with PAs operated by the same neurosurgeon through an EET approach in two Spanish tertiary hospitals in ten years.

Results

242 pituitary surgeries performed in 231 patients were analyzed. In the 154 surgeries performed in 146 patients with non-functioning PAs (NFPAs), 46.8% (n=72) presented presurgical hypopituitarism. After PAs resection, 41 of these (56.9%) normalized pituitary function and 11 of 82 patients with preoperative normal function (13.4%) developed new pituitary deficits. Patients with preoperative visual impairment (OR=3.9, p=0.046) and operated in the first four years of the neurosurgeon's learning curve (OR=5.7, p=0.016) presented a higher risk of developing postoperative hypopituitarism.

Of the 88 surgeries in 85 patients with functioning PAs (FPAs), 23.9% presented presurgical hypopituitarism, and 47.6% of those recovered after surgery. 9% of the cases with preoperative normal function developed new pituitary deficit/s. Diabetic patients presented a higher risk of persistence of hypopituitarism (OR=10.5, p=0.024). Patients with presurgical visual impairment (OR=30.0, p=0.010) and PAs>3cm (OR=14.0, p=0.027) had higher risk of developing new pituitary deficits.

Conclusion

Approximately 50% of patients with PAs and preoperative hypopituitarism recover pituitary function after EET surgery. 10% of patients with normal function develop new deficits. Patients with NFPAs with visual involvement and operated in the first four years of neurosurgeon's learning curve, and FPAs patients with presurgical visual impairment and tumor size>3cm have a higher risk of postoperative hypopituitarism.

Keywords:
Pituitary adenomas
Hypopituitarism
Anterior pituitary dysfunction
Pituitary surgery
Resumen
Objetivo

Identificar factores prequirúrgicos y quirúrgicos asociados con el desarrollo de hipopituitarismo y de su recuperación tras la resección transesfenoidal endoscópica endonasal (TEE) de adenomas hipofisarios (AH).

Métodos

Estudio retrospectivo de pacientes con AH intervenidos mediante abordaje TEE en dos hospitales terciarios por el mismo neurocirujano a lo largo de diez años.

Resultados

Se analizaron 242 cirugías hipofisarias realizadas 231 pacientes. De las 154 cirugías realizadas en 146 pacientes con AH no funcionantes (AHNF), el 46,8% (n=72) presentó hipopituitarismo prequirúrgico. Tras la resección del AH, 41 de los 72 pacientes (56,9%) normalizaron la función hormonal y 11 de 82 pacientes con función preoperatoria normal (13,4%) desarrollaron nuevos déficits hormonales. Los pacientes con afectación visual preoperatoria (OR=3,9, p=0,046) y operados en los primeros cuatro años de la curva de aprendizaje del neurocirujano (OR=5,7, p=0,016) presentaron mayor riesgo de desarrollar hipopituitarismo posoperatorio.

De las 88 cirugías realizadas en 85 pacientes con AH funcionantes (AHF), el 23,9% presentó hipopituitarismo prequirúrgico y el 47,6% de los que presentaban hipopituitarismo se recuperaron tras la cirugía. El 9% de los pacientes con función preoperatoria normal desarrollaron nuevos déficits hormonales. Los pacientes diabéticos presentaron mayor riesgo de persistencia del hipopituitarismo (OR=10,5, p=0,024). Los pacientes con afectación visual prequirúrgica (OR=30,0, p=0,010) y AH>3cm (OR=14,0, p=0,027) presentaron un mayor riesgo de desarrollar nuevos déficits hormonales.

Conclusión

Aproximadamente el 50% de los pacientes con AH e hipopituitarismo preoperatorio recuperan la función hipofisaria después de la cirugía TEE. El 10% de los pacientes con función normal desarrollan nuevos déficits. Los pacientes con AHNF con afectación visual y operados en los primeros cuatro años de la curva de aprendizaje del neurocirujano y los pacientes con AHF con afectación visual prequirúrgica y tamaño tumoral>3cm tienen mayor riesgo de desarrollar hipopituitarismo posoperatorio.

Palabras clave:
Adenomas hipofisarios
Hipopituitarismo
Disfunción adenohipofisaria
Cirugía hipofisaria

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