Department of Neurosurgery, University Hospital of Wales, Cardiff, Wales, CF14 4XW, UK.
Department of Endocrinology, University Hospital of Wales, Cardiff, UK.
Acta Neurochir (Wien). 2021 Feb;163(2):391-398. doi: 10.1007/s00701-020-04609-x. Epub 2020 Oct 21.
The outcome for pituitary endocrine function following endoscopic transsphenoidal surgery remains unclear. This study aims to evaluate endocrine outcomes following endoscopic surgery in order to provide a benchmark to assist in the counselling of patients perioperatively.
A prospectively held pituitary database was retrospectively analysed for all adult pituitary adenoma patients undergoing endoscopic surgery from May 2011 to May 2017. All operations were performed by a single neurosurgeon at a regional centre for pituitary surgery. Functioning and non-functioning adenomas were included. Hormonal status was assessed at most recent follow-up.
One hundred forty-five patients (69 M, 76 F) were included in the study with a median age of 52 years. Median follow-up was 52 months. Eighty-eight patients (61%) were not taking any hormone replacement medications, whilst 57 patients (39%) required hormone replacement therapy (HRT) preoperatively. Preoperatively, 29 patients (20%) had hypothalamo-pituitary-adrenal (HPA) axis dysfunction, 39 patients (27%) had thyroid axis dysfunction, 11 males (16%) and 7 females (9%) had gonadal axis dysfunction, and one patient had preoperative diabetes insipidus. Postoperatively, 26 patients (18%) had a new deficiency in pituitary function, whilst 6 patients (11%) were able to cease HRT. Nineteen patients (13%) had new HPA axis deterioration, 12 (8%) had new thyroid axis dysfunction, 8 males (11%) and 4 females (5%) had gonadal axis deterioration, and 6 patients (4%) had new diabetes insipidus (DI).
The ability to restore pituitary function following endoscopic surgery remains limited, whilst new deficits still occur. It is essential that patients are counselled accordingly as hormonal replacement therapy can have a significant impact on quality of life. Larger longer-term collaborative studies of endocrine outcome in endoscopic pituitary surgery are needed.
经内镜经蝶窦手术（endoscopic transsphenoidal surgery）后的垂体内分泌功能结果仍不清楚。本研究旨在评估内镜手术后的内分泌结果，以为围手术期患者提供咨询的基准。
回顾性分析 2011 年 5 月至 2017 年 5 月期间接受内镜手术的所有成人垂体腺瘤患者的前瞻性垂体数据库。所有手术均由一位神经外科医生在区域性垂体手术中心进行。功能性和非功能性腺瘤均包括在内。在最近的随访中评估激素状态。
本研究纳入了 145 名患者（69 名男性，76 名女性），中位年龄为 52 岁。中位随访时间为 52 个月。88 名患者（61%）未服用任何激素替代药物，而 57 名患者（39%）术前需要激素替代治疗（HRT）。术前，29 名患者（20%）存在下丘脑-垂体-肾上腺（HPA）轴功能障碍，39 名患者（27%）存在甲状腺轴功能障碍，11 名男性（16%）和 7 名女性（9%）存在性腺轴功能障碍，1 名患者患有术前尿崩症。术后，26 名患者（18%）出现新的垂体功能缺陷，6 名患者（11%）能够停止 HRT。19 名患者（13%）出现新的 HPA 轴恶化，12 名患者（8%）出现新的甲状腺轴功能障碍，8 名男性（11%）和 4 名女性（5%）出现性腺轴恶化，6 名患者（4%）出现新的尿崩症（DI）。
内镜手术后恢复垂体功能的能力仍然有限，并且仍然会出现新的缺陷。对患者进行相应的咨询非常重要，因为激素替代治疗会对生活质量产生重大影响。需要更大规模、长期的协作研究来评估内镜垂体手术的内分泌结果。
