Endocrine Abstracts

Target: To study the incidence of postoperative complications in patients with transsphenoidal pituitary adenoectomy.

Materials and research methods: 180 cases of PA subjected to TРА for the period from 2018 to 2020 were analyzed. Of these, 102 (56.6) women, 78 (43.3) men, patients were divided into two alternative groups: the first group - 93 (51.6%) patients with macroadenomas - 42 (45.2%) men, women 51 (54.8%), the second (comparison group) - 87 (48.4%) with microadenomas of men - 35 (40%), women - 52 (60%) of the pituitary gland. The age of the patients ranged from 30 to 59 years. The levels of hormones STH, IGF-1, ACTH, cortisol, prolactin, TSH, fT4, LH, FSH, estradiol, progesterone according to indications, MRT/CT of the chiasmal-sellar area and the state of the organ of vision were studied.

Results: Patients were distributed as follows: depending on the hormonal activity of patients with adrenocorticotropic hormone secreting Cushing’s syndrome-60, аcromegaly-60, inactive pituitary adenoma-60; depending on the size of the formation: 93 (51.6%) were with macroadenomas, 87 (48.3%) with pituitary microadenomas. An analysis of the incidence of postoperative complications in the short term (1 month) revealed that in 81 (45%) patients with hypopituitarism; hypothyroidism in (70)39%; hypogonadism in 50(28%); diabetes insipidus in 7(4%); transient diabetes insipidus in 11(6%); visual acuity deterioration in 2 (1.2%) patients and liquorrhea in 3 (5.4%) patients. At the same time, there was a normalization of elevated hormone levels in 133 (74%) patients; 30% improvement in vision; lack of disease dynamics in 47 (26%). Despite the persistent phenomena of hypopituitarism 47(26%) and diabetes insipidus 11(6%), which were mainly observed in 165(92%) patients with macroadenomas and did not depend on the organ activity of the formation (against 54(30%) cases with microadenomas). In the long-term follow-up of patients after TРА (t 3 months to 1 year), an improvement in pituitary function was noted in the form of restoration of gonadotropic insufficiency, phenomena of transient diabetes insipidus and improvement in hypertensive cephalgia.

Conclusion: The frequency of immediate and long-term complications in most cases is observed in pituitary macroadenomas and does not depend on the hormonal activity of the adenoma.