ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P1091 | DOI: 10.1530/endoabs.63.P1091

Surgical outcomes in acromegaly disease: endoscopic transsphenoidal pituitary surgery

Miriam Cozar1, Pablo Remón-Ruiz2, Elena Dios-Fuentes2, Miriam Cozar1, Ariel Kaen1, Eugenio Cardenas1, Natividad Gonzalez3, Ignacio Martin1, Florinda Roldan1, Elena Fajardo1, David Cano1 & Alfonso Soto-Moreno1

1Virgen del Rocio Hospital, SEVILLA, Spain; 2Virgen del Rocio Hospital, Seville, Spain; 3Virgen Macarena Hospital, Seville, Spain.

Introduction: Endoscopic transsphenoidal pituitary surgery has become the first line method for removal pituitary tumours. A new way to see the surgical field and the cooperation of two neurosurgeons has supposed a revolution in the area.

Objetives: Analyse surgical outcomes and complications of a cohort of patients from a single center who underwent ETPS for GH secreting pituitary tumours.

Methods: Descriptive prospective-retrospective study among patients who underwent ETPS for GH pituitary tumours in a single center from January/2013 to June/2018.

Results: 39 patients underwent ETPS as first line treatment, 24 (61.54%) were women, 15 (38.46%) men, mean surgical age was 48.57 years. 5 (12.82%) were microadenomas and 34 (87.18%) were macroadenomas, 8 (20.51%) were bigger than 25 mm. Cavernous sinus invasion according to Knosp score 3-4, was found in 20 (51.28%) patients, 5 (12.82%) patients had Knosp 4. At december/2018, after a follow-up of 3.1±1.14 years, 28 (71.79%) patients remained cured; cure rate was 100% for microadenomas, for no invasive tumours was 89.47%, for invasive tumours 55%. If we don’t include Knosp 4 tumours (0% cure rate), cure rate for invasive tumours would be 68.75%. 5 patients underwent ETPS after an unsuccessful microscopic transsphenoidal approach. 100% were women; mean surgical age 47.94 years. 100% macroadenomas, 2 (40%) bigger than 25 mm and 3 (60%) with sphenoidal sinus invasion. At december/2018, after this second surgery and with a mean follow-up of 2.1±0.48 years, 3 (60%) patients remained cured. Non cured patients (2, 40%) were non invasive and bigger than 25 mm tumours. From all operated patients, 8 (18.18%) had campimetric commitment; after the intervention a full recovery was observed in 3 (37.5%) patients and partial recovery in 5 (62.5%). As hormonal complications, diabetes insipidous was observed in 2 patients, steroid deficiency in 3 patients, thyroid deficiency in 3 and gonadal dysfunction in 1 patient.

Conclusions: ETPS is an effective and secure surgical approach as first line treatment in GH secreting adenomas. ETPS is an effective approach even in highly invasive adenomas with Knosp 3 sinus invation.

Cure rates in reintervention from MTS put ETPS as an elective second line treatment in patients with relapse of disease after a first surgery.