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Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function

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Abstract

Background

Non-functioning pituitary macroadenomas (NFPAs) with visual field defects are ideally managed by transsphenoidal tumour resection to improve vision, and long-term postsurgical follow up is necessary to monitor for tumour recurrence. Regular updates from global data are necessary for developing optimal management strategies of these tumours.

Methods

Pre- and postoperative visual and endocrine profile, imaging characteristics and details of surgical interventions among patients with NFPAs managed between 2008 and 2019 in a UK regional centre were assessed. The radiological and surgical outcomes including postoperative complications, recurrence risk and the factors influencing outcomes also were assessed.

Results

105 cases with mean (SD) age 60.1 (14.3) years and follow-up duration 60 (37) months were studied. 67 (64%) patients were male. Five-year recurrence-free survival rate was 71.5% (95% confidence interval [CI] 62.7% to 81.6%) with 33 (31%) tumour recurrences of whom 20 (60%) received radiotherapy and 9 (27%) underwent further surgery. Younger age, tumour volume, and bilateral cavernous sinus extension were the predictors of recurrence on univariate analysis, while younger age was the only factor on multivariate analysis (Hazard ratio 0.95; 95% CI: 0.92, 0.97). 72/78 patients (92%) with preoperative visual field defects improved after surgery, of whom 27 (35%) had full recovery. 20 (24%) patients had recovery of an abnormal hormone axis. 15 patients (16%) developed perioperative complications such as cerebrospinal fluid leak (12 cases), meningitis (2 cases), and bleeding (2 cases).

Conclusions

Five-year recurrence-free survival after transsphenoidal resection for NFPAs was 71.5% with older age at surgery conferring lower risk of recurrence. Visual recovery/ improvement occurred in 92% of cases with preoperative visual defects following surgery.

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Author notes

  1. These authors contributed equally: Venkatram Subramanian, Rachel Lee Su Min

Authors and Affiliations

  1. Department of Endocrinology & Metabolism, Royal Preston Hospital, The Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK

    Venkatram Subramanian, Simon Howell, Kalpana Kaushal & Joseph M. Pappachan

  2. The University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Rachel Su Min Lee, Kalpana Kaushal & Joseph M. Pappachan

  3. Department of Neuroradiology, Royal Preston Hospital, The Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK

    Samuel Gregson

  4. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall, UK

    Ian M. Lahart

  5. Manchester Metropolitan University, All Saints Building, Manchester, M15 6BH, UK

    Joseph M. Pappachan

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  1. Venkatram Subramanian
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Subramanian, V., Lee, R.S.M., Howell, S. et al. Non-functioning pituitary macroadenomas: factors affecting postoperative recurrence, and pre- and post-surgical endocrine and visual function. Endocrine 73, 407–415 (2021). https://doi.org/10.1007/s12020-021-02713-1

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