Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2010) 21 P244

SFEBES2009 Poster Presentations Pituitary (65 abstracts)

Management of non-functioning pituitary adenomas in a University Hospital: aretrospective analytical audit

Lakshminarayanan Varadhan , Arjun Mukherjee , Maureen Brown , Richard Clayton & Fahmy Hanna

University Hospital North Staffordshire NHS trust, Stoke on Trent, UK.

Introduction: Pituitary tumors account for 15% of all intracranial neoplasms and could remain asymptomatic for a significant period. We conducted a retrospective analysis to assess pattern of referrals and management of non-functioning pituitary adenomas at our tertiary referral centre.

Methods: Data was collected on referrals for NFA received at our university hospital from 2005 to 2008. Medical records, radiology reports and endocrine department data were analysed to gather relevant data.

Results: Fifty-one patients were referred to our centre during this period, aged between 31 and 89 years, with 30% being females. Of 74.5% of referrals were from within the hospital, the rest being referred from other DGHs. Ophthalmologists were the predominant origin of referrals (33%), followed by general physicians (29%) and GPs (20%). Visual defects were the main presenting symptom (63%), hypogonadism and headache being next. Initial assessment was carried out in 53 days (0–357 days), mainly by endocrinologist (50%) or neurosurgeons (39%).

Seventy-eight percentage had proven visual field defect by perimetry. Forty-two patients had MRI (seven further had CT) and all had pituitary function tests (Table 1). Forty-seven patients underwent surgery, 27 by neurosurgery and the rest by ENT, in 99 days from initial assessment (1–749). Seventy-six percentage were proven as null cell adenoma on histology, followed by Rathke’s cyst and normal pituitary tissue. The mean duration of inpatient stay was 11 days.

Visual fields improved in 70% and one patient’s vision deteriorating. Post operative MRI was organised on 94% in 92 days, showing substantial improvement (Table 1).

Table 1
MRIPituitary status
Suprasellar extensionOptic chiasm involvementNormalPartial anterior hypopit.Total anterior hypopit.Panhypopit.
Preop (%)83676818410
Postop (%)18143240919

Conclusion: The delay between the initial referral and treatment is still substantial. Pituitary surgery improves the visual defects significantly; however the pituitary function could deteriorate.

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