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J Neurol Surg B Skull Base
DOI: 10.1055/a-2081-1427
Original Article

Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Yuanming Geng‡   *
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Qian Dong‡   *
2   School of Nursing, Bengbu Medical College, Anhui, People's of Republic of China
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Zixiang Cong‡   *
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Junhao Zhu
4   Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
,
Zhenxing Li
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Chaonan Du
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Feng Yuan
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Xinrui Zeng
4   Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
,
Alleyar Ali
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
,
Jin Yang 
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Chao Tang
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
,
Chiyuan Ma    *
1   Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
3   Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
4   Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
5   School of Medicine, Southeast University, Nanjing, People's Republic of China
6   Department of Neurosurgery, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, People's Republic of China
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Abstract

Objective Biochemical remission rates of endoscopic endonasal transsphenoidal surgery (EETS) and its associated predictive factors were evaluated in patients with somatotrophin pituitary adenomas.

Methods The patients who underwent EETS in Jinling Hospital were identified between 2011 and 2020. The surgeons' experience, preoperative insulin-like growth factor 1 (IGF-1), basal growth hormone (GH) levels, nadir GH levels, and the tumor characteristics were analyzed for their relationships with endocrine outcomes. Total 98 patients were included for single factor analysis and regression analysis. They were divided into three groups according to the admission chronologic order.

Results The overall remission rate of the patients was 57% (56/98) for all the patients over 10 years. In the single factor analysis, we found that the tumor size, cavernous invasion, and sellar invasion were valuable to predict the endocrine outcome after surgery. As for the suprasellar invasion, no significant difference was found between the noninvasive group and the invasive group. The preoperative IGF-1 level (p = 0.166), basal GH level (p = 0.001), and nadir GH level (p = 0.004) were also different between the remission group and the nonremission group in the single factor analysis. The logistic regression analysis indicated that the preoperative nadir GH (odds ratio = 0.930, 95% confidence interval = 0.891–0.972, p = 0.001) was a significant predictor for the endocrine outcomes after surgery.

Conclusion The surgeons' experience is an important factor that can affect the patients' endocrine outcomes after surgery. The macroadenomas with lateral invasion are more difficult to cure. Patients with higher preoperative nadir GH levels are less likely to achieve remission.

Keywords

pituitary adenoma - acromegaly - growth hormone - cavernous sinus - invasion - Knosp - endoscopic - transsphenoidal surgery

Ethical Approval and Consent to Participate

All patients provided written informed consent. The Institutional Review Board at Jinling Hospital approved the study.


Consent for Publication

The authors declare that the manuscript has not been submitted for publication elsewhere, in whole or in part, in any language. All authors have contributed to, read, and approved the enclosed manuscript.


Authors' Contributions

Y.G., Q.D., Z.C., J.Z., Z.L., C.D., F.Y., X.Z., A.A., J.Y., C.T., and C.M. all contributed to the review of relevant literature, writing, editing, and/or revising of the manuscript.


* These authors contributed equally to this work and share first authorship.




Publication History

Received: 08 February 2023

Accepted: 22 April 2023

Accepted Manuscript online:
26 April 2023

Article published online:
30 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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