Immediate and Delayed Postoperative Morbidity in Pituitary Adenomas

Background Neurosurgical resection is the most widely used definitive treatment for pituitary tumors. The aim of this study was to assess the immediate and delayed postsurgical morbidity in patients affected with pituitary adenomas.

Methods We retrospectively reviewed the data of 137 patients who were operated by the same neurosurgeons in our center between 2002 and 2016. Sixty-two patients underwent surgery using endonasal microscopic approach from 2002 to 2009 and 75 patients underwent surgery using endoscopic transsphenoidal approach from 2008 to 2016. We performed a descriptive and statistical analysis, making a comparison between both approaches and between the different types of adenoma (ACTH-secreting, GH-secreting, and nonfunctioning [NFA] adenomas), focusing on immediate (first month) and delayed (first year) complications.

Results Seventy-six patients were males (55.5%) and 61 were females (44.5%). The mean age at surgery was 50.6 ± 15.5. The most common type of adenoma was NFA (67 patients), followed by GH-secreting adenomas (39 patients) and by ACTH-secreting adenomas (31 patients).

78.1% of the tumors were pituitary macroadenomas, and the remaining 21.9% of them pituitary microadenomas (there were no “not-radiologically visible” adenomas). Tumor size had no statistical influence on 1-year complications (the complication rate was 22.4% for macroadenomas and 13.3% for microadenomas; p = 0.32).

There were 36.5% immediate complications in the endonasal microscopic approach versus 37.8% in the endoscopic transsphenoidal approach (p = 0.99). The most frequent complication was transient diabetes insipidus (27.4 vs. 25.3%), followed by cerebrospinal fluid leakage (8.2 vs. 10.6%). Regarding delayed complications, there were 25.4% complications in the microscopic approach versus 16.2% in the endoscopic approach (p = 0.21), being the new hypopituitarism (22.6 vs. 14.7%) the most frequent one.

We observed that 48.4% of the patients with ATCH-secreting adenomas developed immediate complications (vs. 38.5% of patients with GH-secreting adenomas and 31.3% of patients with NFA; p = 0.27). Delayed complications were observed in 22.6% of patients with ACTH-secreting adenomas, 22.4% of NFA, and 15.4% of GH-secreting adenomas (p = 0.65).

The most frequent immediate complication was transient diabetes insipidus (37 cases: 41.9% of ACTH-secreting adenomas, 23.1% of GH-secreting adenomas, and 22.4% of NFA), followed by cerebrospinal fluid leakage (12 cases: 12.8% of GH-secreting adenomas, 8.9% of NFA and 3.2% of ACTH-secreting adenomas). The most frequent delayed complication was new hypopituitarism, in 25 cases (20.9% of NFA, 19.3% of ACTH-secreting adenomas, and 12.9% of GH-secreting adenomas), followed by permanent diabetes insipidus in 8 cases (7.5% of NFA, 6.5% of ACTH-secreting adenomas, and 2.6% of GH-secreting adenomas).

The age of the patients was not associated with the 1-month and 1-year complication rates (p = 0.36; p = 0.46).

Conclusion We conclude that in our series, we observed lower delayed postsurgical complication rates in the patients who underwent endoscopic transsphenoidal approach. However, this difference did not reach statistical significance and therefore, further prospective studies with larger number of patients are needed to draw definitive answers.

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