Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T20:55:25.076Z Has data issue: false hasContentIssue false
  • English
  • Français

Pituitary Adenomas: Presentations and Outcomes in a South Asian Country

Published online by Cambridge University Press:  02 December 2014

Muhammad Shahzad Shamim ,
Muhammad Ehsan Bari ,
Faraz Khursheed ,
Rashid Jooma  and
Syed Ather Enam
Muhammad Shahzad Shamim
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Muhammad Ehsan Bari
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Faraz Khursheed
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Rashid Jooma
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Syed Ather Enam
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

: The purpose of this retrospective review of all operated cases of pituitary adenomas in the last decade, is to define the demographic patterns and characteristics of such tumors and to assess surgical outcomes with regards to safety and efficacy of trans–sphenoidal tumor removal in our institution.

Methods:

Surgically treated pituitary adenomas presenting from 1995 till 2005 were reviewed for different variables. Results were expressed as mean, standard deviation and median for continuous and number with percentage for categorical data. Chi square test was applied to measure differences and significance was taken at p value < 0.05.

Results:

One hundred and twenty–five patients were operated for pituitary adenoma. Sixty–three percent were male and mean age was 37 years. Sixty percent of the patients presented with headache and/or visual symptoms. Twelve percent presented with pituitary apoplexy and 28% presented with symptoms due to pituitary hyperfunction. Fifty–five percent of patients had functioning and 44% had nonfunctioning adenomas. Mean pre operative tumor diameter from 86 pre op MRI scans was 26.76 mm (3–78 mm). Eighty–four percent of patients underwent trans–sphenoidal tumor resection and three percent had craniotomy. Mean size of post op residual tumor as calculated from 76 available post operative scans was 5.3 mm (range 0–31 mm). 17.6% of the patients required hormone replacement beyond three months and 10% were re–operated. Overall mortality was 1.6%.

Conclusion:

In Pakistan, patients are more likely to present either with apoplexy or with a giant pituitary adenoma than patients reported from developed countries. Overall, our results have been satisfactory and comparable with the literature.

résumé:

<span class='bold'>RÉSUMÉ:</span> <span class='bold'> <span class='italic'>Objectif:</span></span>

Le but de cette revue rétrospective de tous les cas d’adénomes pituitaires opérés au cours de la dernière décennie était de définir le profil démographique et les caractéristiques de ces tumeurs et d’évaluer les résultats chirurgicaux en termes de sécurité et d’efficacité de l’ablation trans–sphénoïdale de la tumeur dans notre institution.

<span class='bold'> <span class='italic'>Méthodes:</span></span>

Nous avons révisé les observations de patients qui ont subi une chirurgie pour adénome pituitaire entre 1995 et 2005. La moyenne, la déviation standard et la médiane ont été calculées pour les variables continues et le pourcentage pour les variables discrètes. Le test du chi–carré a été utilisé pour l’analyse des données et la valeur de p a été fixée à < 0,05.

<span class='bold'> <span class='italic'>Résultats:</span></span>

Cent vingt–cinq patients ont subi une chirurgie pour un adénome pituitaire. L’âge moyen était de 37 ans et 63% étaient des hommes. Soixante pour cent des patients ont consulté initialement pour de la céphalée et/ou des symptômes visuels, 12% pour apoplexie pituitaire et 28% pour des symptômes d’hyperpituitarisme. Chez 55% des patients l’adénome était fonctionnel et chez 44% l’adénome ne l’était pas. Le diamètre moyen de la tumeur avant la chirurgie, évalué au moyen de 86 IRM préopératoires, était de 26,76 mm (3 à 78 mm). Quatre–vingt–quatre pour cent des patients ont subi une résection trans–sphénoïdale de la tumeur et 3% ont subi une craniotomie. La taille moyenne de la tumeur résiduelle en postopératoire, calculée au moyen de 76 scans effectués après la chirurgie, était de 5,3 mm (0 à 31 mm). Un remplacement hormonal s’est avéré nécessaire chez 17,6% des patients au–delà de trois mois et on a dû réintervenir chez 10%. La mortalité globale a été de 1,6%.

<span class='bold'> <span class='italic'>Conclusion:</span></span>

Au Pakistan, les patients consultent plus souvent pour une apoplexie pituitaire ou un adénome géant que dans les pays développés. Dans l’ensemble, nos résultats ont été satisfaisants et ils sont comparables à ceux rapportés dans la littérature.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 2 , May 2008 , pp. 198 - 203
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Kovacs, K, Horvath, E. Tumors of the pituitary gland. Atlas of tumor pathology, fascicle 21, 2nd series. Washington, D.C, Armed Forces Institute of Pathology: 1986. p. 1–269.Google Scholar
2. Cardoso, E, Peterson, E. Pituitary apoplexy: a review. Neurosurgery. 1984; 14:363–73.Google Scholar
3. Reinecke, M, Allelio, B, Saeger, W, Menzel, J, Winkelman, W. The incidentaloma of the pituitary gland. Is neurosurgery required? JAMA. 1990; 263:2772–6.Google Scholar
4. Laws, ER, Kern, EB. Complications of transsphenoidal surgery. In Laws, ER, Randall, RV, Kern, EB, Abboud, CF, editors. Management of pituitary adenomas and related lesions with emphasis of transsphenoidal microsurgery. New York, Appleton-Century-Crofts 1982; p. 329–46.Google Scholar
5. Dyer, EH, Civit, T, Visot, A. Transsphenoidal surgery for pituitary adenomas in children. Neurosurgery. 1994; 34:207–12.Google Scholar
6. Chandana, A, Islam, N, Jabbar, A, Zuberi, L, Haque, N. Clinical features and outcome of surgery in 30 patients with Acromegaly. J Pak Med Assoc. 2004; 54:6; 315–19.Google Scholar
7. Chong, BW, Kucharczyk, W, Singer, W, George, S. Pituitary gland MR. A comparative study of healthy volunteers and patients with microadenomas. AJNR Am J Neuroradiol. 1994; 15:4; 675–9.Google Scholar
8. Ciric, I, Ragin, A, Baumgartner, C, Pierce, D. Complications of transsphenoidal surgery: results of a national survey, review of literature, and personal experience. Neurosurgery. 1997; 40:2; 225–36.Google Scholar
9. Goel, E, Nadkarni, T, Muzumdar, D, Desai, K, Phalke, U, Sharma, P. Giant Pituitary Tumors: A study based on Surgical Management of 118 cases. Surg Neurol. 2004; 61:436–46.Google Scholar
10. Laws E Surgical Management of Pituitary apoplexy. In Welch, K, Caplan, L, Reis, D, et al, editors. Primer on Cerebrovascular Diseases. New York Academic Press 1997:p. 221–310.Google Scholar
11. Hardy, J., Transsphenoidal surgery of the normal and pathological pituitary. Clin Neurosurg. 1969; 16:185–217.Google Scholar
12. Jefferson, G, Extrasellar extension of pituitary adenomas. Proc R SocMed. 1940; 33:433–58.Google ScholarPubMed
13. Laws, ER Transsphenoidal approach to pituitary tumors. In: Shmeidek, HH, Sweet, WH, editors. Operative neurosurgical techniques, vol. 1, Philedelphia: WB Saunders; 1995; p. 283–92.Google Scholar
14. Laws, ER Transsphenoidal Surgery. In Apuzzo, MLJ, editor. Brain surgery: complications, avoidance and management, vol. 1, New York: Churchill Livingstone; 1993; p. 357–62.Google Scholar
15. Thapar, K, Laws, ER. Pituitary tumors: Functioning and nonfunctioning. In: Winn, HR, editor. Youman’s Neurological Surgery. 5th Ed. Philedelphia: WB Saunders; 2004. p. 1169–206.Google Scholar
16. Zervas, NT. Surgical results for pituitary adenomas: Results of an interventional survey. In: Black, PM, Zervas, NT, Ridgeway, EC, Martin, J, editors. Secretory tumors of the pituitary gland. New York: Raven Press; 1984; p. 377–85.Google Scholar
17. Semple, P, Laws, E. Complications in a contemporary series of patients who underwent transshpenoidal surgery for Cushing’s disease. J Neurosurg. 1999; 91:175–9.Google Scholar
18. Laws, ER. Vascular complications of transsphenoidal surgery. Pituitary. 1999; 2:163–70.Google Scholar
19. Mindermann, T, Wilson, CB. Age related and gender related occurrence of pituitary adenomas. Clin Endocrinol. 1994; 41:359–64.CrossRefGoogle ScholarPubMed
20. Shamim, SM, Hameed, K. Surgically treated rectal prolapse: experience at a teaching hospital. J Pak Med Assoc. 2005; 55 (6):247–50.Google ScholarPubMed
21. Yamada, S, Aiba, T, Horvath, E, Kovacs, J. Morphological study of clinically non-secreting pituitary adenomas in patients under 40 years of age. J Neurosurg. 1991; 75:902–5.Google Scholar
22. Annegers, JF, Coulam, CB, Abbound, CF. Pituitary adenoma in Olmstead County, Minnesota, 1935-1977. A report of increasing incidence in women of child bearing age. Mayo Clin Proc. 1978; 53:641–3.Google Scholar
23. Pollack, IF. Brain tumors in children. N Engl J Med. 1994; 331:1500–7.Google Scholar
24. Partington, MD, Davis, DH, Laws, ER Jr, Scheithauer, BW. Pituitary adenomas in children and adolescence. J Neurosurg. 1994; 80:209–16.CrossRefGoogle Scholar
25. Bills, D, Meyer, F, Laws, E, et al. A retrospective analysis of Pituitary apoplexy. Neurosurgery. 1993; 33:602–9.Google Scholar
26. Laws, ER. Pituitary surgery. Endocrinol Metab Clin North Am. 1999; 28:119–31.Google Scholar