Background: Endoscopic trans-sphenoidal surgery is a technical advance for treatment of pituitary tumours. We present the outcomes of patients with Acromegaly or Cushings disease undergoing selective pituitary adenomectomy in a regional neurosurgical centre.
Methods: Retrospective cohort study August 2010-August 2017. Imaging, histology and pituitary hormone assessments were collated pre and post-operatively to quantify patient hormonal outcomes.
Results: 25 patients with Acromegaly or Cushings disease underwent resection (13 Acromegaly and 12 Cushings disease.)
Acromegaly group: - Mean age at surgery - 50.6 years
- 9 patients had no pre-operative hormone deficiency and 4 had a deficiency of 1 hormone. None had multiple hormone deficiencies.
- Post-operatively, at last follow up (mean follow up 38.25 months), 7 patients had no hormone deficiency, 2 were deficient in 1 hormone, and 2 in 2-3 hormones. 1 patient died (unrelated to surgery) and 1 lost to follow up.
- 2 patients required no further adjuvant therapy/surgery and 3 required repeat surgery, one of which was curative. Remaining patients (8) required a combination of radiotherapy and/or medical therapy.
Cushings group: - Mean age at surgery - 43.5 years.
- 11 patients had no hormone deficiency pre-operatively and 1 patient had 1 hormone deficiency.
- Post-operatively, at last follow up (mean follow up 32.8 months,) 5 patients had no hormone deficiency, 5 an isolated hormone deficiency, 2 were lost to follow up.
- 6 patients required no further treatment. 3 required re-do surgery, 1 of which was curative. 3 patients needed medical adjuvant treatment.
Conclusion: We present the outcomes of patients following endoscopic trans-sphenoidal surgery for Acromegaly and Cushings disease. The need for repeat surgery was low in both groups and when needed, it was not curative in 66% of cases.
There is no significant damage to pituitary gland function as a result of surgery.