Frequency of a postoperational hypopituitarism in patients with pituitary tumors after transnasal hypophysectomies
Yulduz Urmanova & Mukhlisa Shakirova
Study objective: To estimate frequency of a postoperational hypopituitarism after transnasal hypophysectomies (TNHE) in patients with pituitary adenomas.
Material and methods: Under our observation there were 24 patients with various pituitary adenomas, of them: 14 females, 10 males; the middle age being 36.4 years. According to the aetiology of the basic disease the patients were sorted out as follows: 17 patients had an inactive pituitary adenoma, 1 craniofaringeoma, 2 Cushings disease, 2 prolactinoma, 1 astrocytoma, 1 meningioma.
The 24 patients during the period from 2007 to 2009 underwent 33 surgical operations under the guidance of Dr M P Powell (Great Britain) in neurosurgery department of the Republican Scientific Centre of Emergency Medical Aid (the head Prof. K E Mahkamov), of them TNHE was done on 32 patients, bifrontal craniotomy on 1 patient. Herewith 3 patients underwent TNHE 2 times, 3 3 times. Four patients underwent radial therapy as well.
All patients underwent a complex of examinations including radio immune hormonal (STH, IGF1, prolactinum, LH, FSH, TSH, ACTH, hydrocortisone, etc.), ophthalmologic (an eyeground, visual fields) and X-ray examination (C?, MRI of cella turcica).
Results: According to our data, postoperational panhypopituitarism (deficiency of GH, LH, FSH, ACTH+diabetes insipidus) developed in 6 patients (25%), postoperational partial hypopituitarism (deficiency of GH, LH, FSH) in 11 (45.8%) and GH deficiency in 7 (29.1%) patients. Thus, the most obvious neuroendocrinal disturbances after TNHE were revealed in 6 (25%) patients.
Conclusions: i) In the patients with pituitary adenomas who underwent TNHE, the monitoring of all stimulating and peripheral pituitary hormones levels is recommended both in the early and later postoperative periods. ii) Patients with pituitary adenomas after TNHE require substitutive hormonal therapy by corresponding preparations depending on the level of hormones (desmopressin, sexual and thyroid hormones, corticosteroid preparations, GH).