Endocrine Abstracts

Introduction: For clinically relevant sellar masses, early identification and effective endocrine & surgical management is the key. National Hospital of Sri Lanka (NHSL), which is the largest tertiary care centre in Sri Lanka, manages a wide variety of patients with sellar/supra-sellar pathologies, regularly conducting pituitary related surgeries. The aim of the current study was to determine epidemiological and clinical characteristics as well as immediate post-operative course of the patients undergoing pituitary surgeries.

Methods: Prospective, cross-sectional study of demographics, clinical & biochemical characteristics & post-operative course of all adult patients (above 15 years) undergoing pituitary related surgeries in NHSL over 18 months from February 2019.

Results: During this period, 139 persons underwent pituitary related surgeries, with a mean age of 44 years (+/- 15) and a female to male ratio of 3:2. 25% had re-operations while the rest were first surgeries. The majority (68.3%) presented with pressure symptoms while 10.1% & 20.1% presented with hypopituitarism & hormone hypersecretion respectively. Sixty-seven (48.2%) were on pre-operative Levothyroxine, with 12 of them having long standing primary hypothyroidism. Forty-seven (33.8%) patients were on pre-operative long term hydrocortisone replacement. Pituitary adenoma in 111 (79.9%), craniopharyngioma in 22 (15.8%), and supra-sellar meningioma in 6 (4.3%) were observed. MRI of sellar masses demonstrated cavernous sinus invasion in 49 (35.3%), while 80 (57.6%) had optic chiasm compression. Out of pituitary adenomas, the majority 81 (72%) had non-functioning adenoma, 20 (18%) had Acromegaly, 9 (8.1%) had Cushing’s and 1 patient with resistant prolactinoma underwent surgery. The majority, 108 (77.7%) were trans-sphenoidal surgeries, while 31 (22.3%) underwent craniotomy. Post-operative complications observed were CSF rhinorrhoea in 25 (18%), bleeding in 8 (5.8%), progressive deterioration of vision in 21(15%) and ischemic stroke in 2 persons. No significant difference was observed with the type and attempt of surgery with these complications. Fifty-two developed post-operative transient or permanent cranial Diabetes Insipidus while 12 (8.6%) had Syndrome-of-inappropriate-ADH secretion. 137 (99%) were discharged on hydrocortisone. Post-operative Levothyroxine was required in 74(53%) with a significant difference in the re-operation group compared to first surgery (P=0.02).

Conclusion: This study identifies baseline characteristics of patients undergoing pituitary-related surgeries in a south Asian developing country, along with immediate post-operative complications. These findings have a national & a regional relevance in improving patient care. This will also have a global relevance due to the rising ethnic diversity all over the world.