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Endocrine Abstracts (2022) 81 EP793 | DOI: 10.1530/endoabs.81.EP793

ECE2022 Eposter Presentations Pituitary and Neuroendocrinology (211 abstracts)

Importance of neurosurgical expertise and multidisciplinary approach in pituitary patients

Simone Pederzoli1,2, Maria Laura Monzani1, 2, Sara De Vincentis21, 2, Bruno Madeo1, Chiara Diazzi1 & Vincenzo Rochira1,2

1Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy; 2Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

Background: Multidisciplinary approach to pituitary disease is highly recommended; it requires a close relationship between expert pituitary surgeons and endocrinologists together with several specialists (e.g. neuroradiologists) in order to provide a high-level standard of care. Although there is evidence that neurosurgeons’ expertise is a key element to achieve better outcomes, also endocrinologists’ role is fundamental but it may sometimes encounter real-life barriers.

Aim of the study: To explore from a real-life database the impact of neurosurgical centre expertise on post-surgical outcomes in pituitary patients attending a tertiary academic medical centre.

Methods: A retrospective, observational, single-centre study was carried out including all patients attending the Endocrinology Unit of Modena (Italy) that underwent pituitary surgery from January 1995 to December 2020. For each patient, pre-operative features of the pituitary lesion, surgery information and post-surgical outcomes (i.e. residual neoplasia, surgery-related complications and pituitary function) were collected from record charts. Patients were grouped according to the expertise degree of the centre where they underwent surgery: Group1 included patients treated in neurosurgical centres with high expertise in pituitary surgery (defined as >50 transsphenoidal pituitary surgeries per year); Group2 included patients treated in neurosurgical centre performing <50 transsphenoidal pituitary surgeries per year.

Results: A total of 132 patients (67 men, 65 women; mean age at surgery 50.4±16.8 years) were included. Considering the histological diagnosis, 114 patients (86.4%) had a pituitary adenoma, 11 patients (8.3%) had a craniopharyngioma, and 7 patients (5.3%) had other rarer diagnoses. Group1 included 63 patients (47.7%) and Group2 included 69 patients (52.3%). A pre-surgical endocrinological evaluation was performed in almost all patients with adenoma (89.3%), and just only in 37.5% of patients with craniopharyngioma (P<0.001). Interestingly, patients without a pre-operative endocrinological evaluation were significantly more frequent in Group2 (26.3%) than Group1 (1.9%) (P<0.001). We analysed post-surgical outcomes focusing on pituitary adenoma patients. Patients in Group2 had an almost eight-fold increased likelihood to have residual neoplasia (OR: 8.53; 95% CI: 3.45-21.09) and five-fold increased likelihood to have hypopituitarism (OR: 5.53; 95% CI: 2.41-12.73), while no difference was found for post-surgical complications (9.6% in Group1 vs 22.4% in Group2; P=0.070).

Conclusions: This study confirms that high pituitary neurosurgical expertise is essential to achieve better post-surgical outcomes. The lack of pre-operative endocrinological evaluation is significantly associated to surgery performed in a not-experienced centre. A close multidisciplinary cooperation between experienced endocrinologists and neurosurgeons is required both before and after surgical procedures.

Volume 81

European Congress of Endocrinology 2022

Milan, Italy
21 May 2022 - 24 May 2022

European Society of Endocrinology 

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