Case notes of 150 consecutive patients (58% male) who underwent pituitary surgery by a single surgeon for non-functioning pituitary adenoma and endocrine follow up at our centre between July 2005 and February 2015 were reviewed. All patients underwent endoscopic transsphenoidal surgery as the first approach. Post-operative pituitary function was assessed by measurement of baseline pituitary hormonal profile and a glucagon stimulation test to assess ACTH and GH axis. Mean age at surgery was 61 years (range 2387 years). Pre-operatively, 63.3% of patients had evidence of hypopituitarism and vision was affected in 58% of patients. Post-operatively, hypopituitarism was detected in 70% of patients. New hormone deficiency developed in 25.3% of patients. Post-operative vision improved 46.6% of the total cohort and remained static in 47.3% of patients. During this time period, 10% of patients underwent further surgery and 28% of patients were referred for radiotherapy. To assess if increasing surgical experience affected patient outcomes, data was assessed in two time periods; patients undergoing surgery in the early years between 2005 and 2010 (n=67) and patients undergoing surgery in the latter years between 2011 and 2015 (n=83). There was no significant difference between pre-op hypopituitarism between these groups however, there was a statistically significant difference in terms of post-operatively hypopituitarism, with a lower number of patients in the latter group experiencing post-operative hormone deficiency (79.1% vs 62.7%, P=0.033). Furthermore, there was a statistically significant difference in terms of pre-operative visual status, with more patients in the latter group without any visual compromise (28.4% vs 51.8%, P=0.008). There was no significant difference in terms of post-operative visual outcomes. In conclusion, data from our cohort demonstrates improved endocrine outcome with increasing surgical experience over time. It also highlights change in clinical practice in our centre with more patients undergoing surgery prior to the development of visual symptoms.
20 May 2017 - 23 May 2017