Endocrine Abstracts

In our country, as in others, there is a lack of data on the success rate of transsphenoidal surgery for producing pituitary adenomas. We evaluated the results reported in TESSPAIN, a retrospective multicenter nationwide project that includes all the TSS performed in the participating centers in the period between 2018 and 2022, both included. Surgical treatment success is defined according to the published criteria for each disease: normal IGF-1 and GH after 75 g of oral glucose less than 0.4 ng/ml for GH-producing adenomas; adrenal insufficiency for Cushing´s disease (CD); serum prolactin less than 10 ng/ml for prolactinomas; and resolution of hyperthyroidism for TSH-producing adenomas. We evaluated the global success rate in each center, its correlation with the volume of surgeries and with the number of neurosurgeons performing the surgeries, and the relative success rate including only adenomas retrospectively deemed as curable by an expert endocrinologist in each center, I.e. excluding those with unresectable invasion (Knosp 3b or 4). A total of 911 patients were enrolled in the study: 436 patients with acromegaly, 323 patients with CD, 127 patients with prolactinomas, and 25 TSH-producing adenomas. Overall, the rate of successful surgery was 58.5% for GH-producing adenomas (255/425), which increased to 85.0% when only those considered potentially curable were included (255/370). The surgical success rate for CD was 71.5% (231/323), increasing to 74.8% when only surgically resectable adenomas were included (231/309). The cure rates for PRL-secreting adenomas were 39.4% (50/127) and 76.9% (50 of 65 surgically resectable adenomas), and for TSH-secreting adenomas were 88% (22/25) and 92% (22 of 23 surgically resectable adenomas). The success rate did not correlate with surgical volume, although it showed a positive trend for GH-secreting adenomas (p: 0.43). Although the overall surgical success rate showed no statistically significant differences between centers with a dedicated neurosurgeon and centers with more than one neurosurgeon, the mean surgical success rates were not significantly higher in acromegaly (60.4±11.0 vs 52.1±26.1; P: 0.24) and Cushing’s disease (74.8±18.6 vs 55.5±34.3; P: 0.06). We show the results of TSS for producing pituitary adenomas in our country, with success rates similar to those reported in other countries. We note the high success rate in TSH-secreting adenomas, which probably reflects the earlier actual diagnosis, before the tumor develops invasiveness, and the trend towards better results in centers with a dedicated neurosurgeon, probably not significant because of the low volume of surgeries.