Preoperative and Early/Late Postoperative Evaluation of Endocrine Functions of Patients who Underwent Pituitary Surgery
Öz
Introduction and Aim: Pituitary masses may lead to hormonal insufficiencies due to compression or postoperatively. We evaluated preoperative and early/late postoperative endocrine functions of the patients
Material and Method: In our study, a total of 103 patients were included. Patients’ preoperative endocrine functions, as well as endocrine functions during early postoperative period (first 3 months), at the postoperative year 1 and at the final visit were recorded to be analyzed.
Results: Of our patients, 52.4% were male and 47.6% female, with a mean age of 46.6±13.4 years. Patients were found to have a mean tumor diameter of 2.21±1.07 cm and a mean duration of follow-up of 2.6±1.5 years. Median number of pituitary insufficiency in our patients was 1 preoperatively, 3 within first 3 postoperative months, 2 at postoperative year 1, and 2 at the final visit. DI was found preoperatively in 6.8% preoperatively, at postoperative week 2 in 77.7%, at postoperative month 3 in 54.4%, and at the final visit in 54.4% patients. Hypothyroidism was observed preoperatively in 14.6% and at the 3rd month in 59.2%. Adrenal insufficiency developed preoperatively in 12.6%, and at the 3rd month in 56.3%. Hypogonadism, however, was observed preoperatively in 35.9% and at the 3rd month visit in 65%.
Discussion: We observed that rates of particularly DI and adrenal insufficiency significantly increased at the postoperative month 3 compared with the preoperative period and tended to reduce at 12th month visits. Thusly, considering eventual recovery of hormonal deficiencies, postoperative monitoring of endocrine functions is crucial for treatment management.
Anahtar Kelimeler
Pituitary Adenoma Pituitary Surgery Pituitary Insufficiency Diabetes insipidus
Kaynakça
- 1. Harary M, DiRisio AC, Dawood HY, et al. Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas. Journal of Neurosurgery. 2018; 131(4):1142-51.
- 2. Esposito D, Olsson DS, Ragnarsson O, et al. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019; 22(4):422-34.1
- 3. Brucker-Davis F, Oldfield EH, Skarulis MC,et al Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. The Journal of Clinical Endocrinology & Metabolism. 1999; 84(2):476-86.
- 4. KU KW. Gonadotropin-Relasing Hormone and Gonadotropins in Endocrinology. In:DeGroot LJ JJ, editor 5th ed Philadelphia: Elsevier Saunders. 2006.
- 5. Pritchard L, Turnbull A, White A. Pro-opiomelanocortin processing in the hypothalamus: impact on melanocortin signalling and obesity. Journal of Endocrinology. 2002; 172(3):411-21.
- 6. Schneider HJ,Aimaretti G,Kreitschmann-Andermahr I et al. Hypopituitarism.Lancet 2007 ;369:1461-70
- 7. Vingerhoets F, De Tribolet N. Hyponatremia hypo-osmolarity in neurosurgical patients.“Appropriate secretion of ADH” and “cerebral salt wasting syndrome”, Acta neurochirurgica. 1988; 91(1-2):50-4
- 8. Bladowska J, Sokolska V, Sozański T, et al. Comparison of post-surgical MRI presentation of the pituitary gland and its hormonal function, Polish Journal of Radiology, 2010; 75(1):29.
- 9. Roelfsema F, Biermasz NR, Pereira AMJP. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis, Pituitary. 2012; 15(1):71-83.
- 10. Charalampaki P, Ayyad A, Kockro RA, et al. Surgical complications after endoscopic transsphenoidal pituitary surgery, Journal of Clinical Neuroscience. 2009; 16(6):786-
- 11. Densel A, Bozkurt H, İsmail K, Üstün ME. Hipofiz adenomlarinda transsfenoidal mikrocerrahinin endokrinolojik kür üzerine etkisi, Bozok Tıp Dergisi, 2017; 7(1):32-9.
- 12. de Vries F, Lobatto DJ, Verstegen MJ,et al . Postoperative diabetes insipidus: how to define and grade this complication?, Pituitary 2021; 24:284-291
- 13. Klose M, Lange M, Kosteljanetz M, Poulsgaard L, Feldt‐Rasmussen U. Adrenocortical insufficiency after pituitary surgery: an audit of the reliability of the conventional short synacthen test. Clinical endocrinology. 2005; 63(5):499-505.
- 14. Liu Z, Zhang H, Liu S, Chen H. The functional evaluation of pituitary in patients with a surgical resection of sellar tumours. Archives of medical science: AMS. 2020; 16(2):460-5.
- 15. Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery, Therapeutic advances in endocrinology and metabolism. 2017; Mar8(3):33-48
- 16. Esposito D, Olsson DS, Ragnarsson O, Buchfelder M, Skoglund T, et al.Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management, Pituitary. 2019; 22(4):422-34.
Hipofiz Ameliyatı Olan Hastaların Preoperatif ve Postoperatif Erken/Geç Dönemde Endokrin Fonksiyonlarının Değerlendirilmesi
Öz
Giriş ve Amaç: Hipofiz kitlelerinde bası bulgularına bağlı veya cerrahi sonrası hormonal yetmezlikler gelişebilir. Post-op hipofizer yetmezlik gelişen hastalarda endokrin fonksiyonlar zamanla düzelebilir. Bu hastaların endokrin fonksiyonları açısından takibi; hastanın ömür boyu replasman tedavisi almaması açısından önemlidir. Çalışmamızda kliniğimizde takip olan hastaların preoperatif ve postoperatif erken/geç dönem endokrin fonksiyonlarını değerlendirdik ve endokrinolojik değerlendirmenin önemini vurgulamayı amaçladık.
Materyal ve metod: Çalışmamıza hipofiz operasyonu geçirmiş olan ve kliniğimizde takipli 18 yaş ve üzeri 103 hasta dahil edildi. Hastaların preoperatif ve postoperatif erken dönem (ilk 3 ay), postoperatif 1. yıl ve hastanın son vizitindeki endokrin fonksiyonlar kaydedildi ve analizler gerçekleştirildi.
Bulgular: Hastalarımızın 54 (%52,4)’ü erkek, 49 (%47,6)’u kadındı ve yaş ortalamaları 46,6±13,4 yıl olarak belirlendi. Çalışmaya dahil edilen hastalardan 85 (%82,5)’inin hipofiz adenomu tanısı aldığı tespit edildi. Hastaların ortalama tümör çapları 2,21±1,07 cm ve takip süreleri 2,6±1,5 yıl olduğu saptandı. Hastalarda hipofiz yetmezlik sayısı medyan değerleri preoperatif dönemde 1, postoperatif ilk 3 ayda 3, postoperatif 1. yılda 2, son vizitte ise 2 olarak tespit edildi. Preoperatif dönemde 7 hastada (%6.8) DI mevcutken, postoperatif 2. haftada 80 (%77,7), postoperatif 3. ayda 56 hastada (%54.4) DI mevcuttu. Hastaların son takiplerinde ise 33 hastada (%32) DI tespit edildi. Preoperatif hastaların %14,6’sında 3. ayda %59,2’sinde hipotiroidi mevcuttu. Adrenal yetmezlik, preoperatif dönemde %12,6 olarak görülürken 3. ayda %56,3 düzeylerinde tespit edildi. Hipogonadizm ise preoperatif dönemde %35,9 oranında görülürken 3. ay kontrollerinde %65 düzeylerindeydi. Fonksiyonel ve nonfonksiyel hipofiz adenomlarında cerrahi öncesi ve sonrasında gelişen hipofizer yetmezlik oranları karşılaştırıldığında aralarında anlamlılık bulunmadı.
Anahtar Kelimeler
Hipofiz Adenomu Hipofiz cerrahisi Hipofizer yetmezlik Diabetes insipidus
Kaynakça
- 1. Harary M, DiRisio AC, Dawood HY, et al. Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas. Journal of Neurosurgery. 2018; 131(4):1142-51.
- 2. Esposito D, Olsson DS, Ragnarsson O, et al. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019; 22(4):422-34.1
- 3. Brucker-Davis F, Oldfield EH, Skarulis MC,et al Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. The Journal of Clinical Endocrinology & Metabolism. 1999; 84(2):476-86.
- 4. KU KW. Gonadotropin-Relasing Hormone and Gonadotropins in Endocrinology. In:DeGroot LJ JJ, editor 5th ed Philadelphia: Elsevier Saunders. 2006.
- 5. Pritchard L, Turnbull A, White A. Pro-opiomelanocortin processing in the hypothalamus: impact on melanocortin signalling and obesity. Journal of Endocrinology. 2002; 172(3):411-21.
- 6. Schneider HJ,Aimaretti G,Kreitschmann-Andermahr I et al. Hypopituitarism.Lancet 2007 ;369:1461-70
- 7. Vingerhoets F, De Tribolet N. Hyponatremia hypo-osmolarity in neurosurgical patients.“Appropriate secretion of ADH” and “cerebral salt wasting syndrome”, Acta neurochirurgica. 1988; 91(1-2):50-4
- 8. Bladowska J, Sokolska V, Sozański T, et al. Comparison of post-surgical MRI presentation of the pituitary gland and its hormonal function, Polish Journal of Radiology, 2010; 75(1):29.
- 9. Roelfsema F, Biermasz NR, Pereira AMJP. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis, Pituitary. 2012; 15(1):71-83.
- 10. Charalampaki P, Ayyad A, Kockro RA, et al. Surgical complications after endoscopic transsphenoidal pituitary surgery, Journal of Clinical Neuroscience. 2009; 16(6):786-
- 11. Densel A, Bozkurt H, İsmail K, Üstün ME. Hipofiz adenomlarinda transsfenoidal mikrocerrahinin endokrinolojik kür üzerine etkisi, Bozok Tıp Dergisi, 2017; 7(1):32-9.
- 12. de Vries F, Lobatto DJ, Verstegen MJ,et al . Postoperative diabetes insipidus: how to define and grade this complication?, Pituitary 2021; 24:284-291
- 13. Klose M, Lange M, Kosteljanetz M, Poulsgaard L, Feldt‐Rasmussen U. Adrenocortical insufficiency after pituitary surgery: an audit of the reliability of the conventional short synacthen test. Clinical endocrinology. 2005; 63(5):499-505.
- 14. Liu Z, Zhang H, Liu S, Chen H. The functional evaluation of pituitary in patients with a surgical resection of sellar tumours. Archives of medical science: AMS. 2020; 16(2):460-5.
- 15. Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery, Therapeutic advances in endocrinology and metabolism. 2017; Mar8(3):33-48
- 16. Esposito D, Olsson DS, Ragnarsson O, Buchfelder M, Skoglund T, et al.Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management, Pituitary. 2019; 22(4):422-34.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Sistemleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 21 Haziran 2025 |
| Gönderilme Tarihi | 3 Ocak 2025 |
| Kabul Tarihi | 20 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 47 Sayı: 2 |
