Endocrinologic Outcome Following Endonasal Transphenoidal Excision of Growth Hormone Secreting Pituitary Adenomas

Authors

  • Ali Aafee Senior Resident, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0003-3480-6857
  • Bikesh Khambu Assistant Professor, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 000-0002-7369-589X
  • Rajiv Jha Professor, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0002-2830-7835
  • Prakash Bista Professor and Head of Department, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0002-4811-6964

DOI:

https://doi.org/10.61814/jkahs.v6i2.576

Keywords:

Acromegaly, Endoscopy, Outcomes, Short-term, Trans-sphenoidal

Abstract

Background: Endonasal Transphenoidal Approach for excision of pituitary adenomas has been gaining popularity over the traditional microsurgical approach. The objective of this study is to assess the rate of hormonal recovery following endonasal transphenoidal excision of growth hormone secreting pituitary macroadenoma in out center.

Methods: In this prospective observational study all cases subjected to endonasal transphenoidal excision of growth hormone secreting pituitary adenoma, during the study period from January 2019 to December 2020 at National Neurosurgical Referral Center, Bir Hospital, Kathmandu were included in this study. Preoperative and postoperative patient characteristics were recorded. Hormonal remission was defined as normal insulin-like growth factor-1 level at 3 months follow-up.

Results: A total of 24 cases were included. The mean age of acromegaly cases was 39.42±10.41 years (24-56 years), with male to female ratio of 0.71:1. Majority (9) of cases had a Knosp grade 1.Thirteen cases had a Wilson-Hardy Extension Grade 0. Majority (11) of cases had a Wilson-Hardy Invasion Grade I. Three cases developed post-operative CSF leak, which recovered after lumbar drainage with no sequel. Five cases developed epistaxis which resolved with nasal packing. Sixty three percent (15 cases) had normal IGF-1 levels at 3 months follow up.

Conclusion: Endoscopic endonasal transphenoidal approach to excision of growth hormone secreting pituitary adenomas is a safe and effective modality at achieving hormonal control in our setting.

Author Biographies

Ali Aafee, Senior Resident, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0003-3480-6857

Senior Resident, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0003-3480-6857

Bikesh Khambu, Assistant Professor, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 000-0002-7369-589X

Assistant Professor, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 000-0002-7369-589X

Rajiv Jha, Professor, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0002-2830-7835

Professor, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0002-2830-7835

Prakash Bista, Professor and Head of Department, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0002-4811-6964

Professor and Head of Department, National Neurosurgical Referral Center, National Academy of Medical Sciences, Kathmandu, Nepal. ORCHID id: 0000-0002-4811-6964

References

Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004 Feb;25(1):102–52. https://doi.org/10.1210/er.2002-0022. https://pubmed.ncbi.nlm.nih.gov/14769829/

Melmed S. Acromegaly pathogenesis and treatment. J Clin Invest. 2009 Nov;119(11):3189–202. https://doi.org/10.1172/JCI39375. https://pubmed.ncbi.nlm.nih.gov/19884662/

Fernandez A, Karavitaki N, Wass JAH. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010 Mar;72(3):377–82. https://doi.org/10.1111/j.1365-2265.2009.03667.x. https://pubmed.ncbi.nlm.nih.gov/19650784/

Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf). 1994 Jul;41(1):95–102. https://doi.org/10.1111/j.1365-2265.1994.tb03789.x. https://pubmed.ncbi.nlm.nih.gov/8050136/

Babu H, Ortega A, Nuno M, Dehghan A, Schweitzer A, Bonert HV, et al. Long-Term Endocrine Outcomes Following Endoscopic Endonasal Transsphenoidal Surgery for Acromegaly and Associated Prognostic Factors. Neurosurgery. 2017 Aug 1;81(2):357–66. https://doi.org/10.1093/neuros/nyx020. https://pubmed.ncbi.nlm.nih.gov/28368500/

Xie T, Liu T, Zhang X, Chen L, Luo R, Sun W, Hu F, Yu Y, Gu Y, Lu Z. Time to Revive the Value of the Pseudocapsule in Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone Adenomas. World Neurosurg. 2016 May;89:65-71. doi: 10.1016/j.wneu.2016.01.036. https://pubmed.ncbi.nlm.nih.gov/26805694/

Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993 Oct;33(4):610–7; discussion 617-618. https://doi.org/10.1227/00006123-199310000-00008. https://pubmed.ncbi.nlm.nih.gov/8232800/

Hardy J, Vezina JL. Transsphenoidal neurosurgery of intracranial neoplasm. Adv Neurol. 1976;15:261–73. https://pubmed.ncbi.nlm.nih.gov/945663/

Wilson CB. A decade of pituitary microsurgery. The Herbert Olivecrona lecture. J Neurosurg. 1984 Nov;61(5):814–33. https://doi.org/10.3171/jns.1984.61.5.0814. https://pubmed.ncbi.nlm.nih.gov/6092567/

Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020 Apr 1;105(4). https://doi.org/10.1210/clinem/dgz096. https://pubmed.ncbi.nlm.nih.gov/31606735/

Marko NF, LaSota E, Hamrahian AH, Weil RJ. Comparative effectiveness review of treatment options for pituitary microadenomas in acromegaly. J Neurosurg. 2012 Sep;117(3):522–38. https://doi.org/10.3171/2012.4.JNS11739. https://pubmed.ncbi.nlm.nih.gov/22725987/

Tseng F-Y, Huang T-S, Lin J-D, Chen S-T, Wang P-W, Chen J-F, et al. A registry of acromegaly patients and one year following up in Taiwan. J Formos Med Assoc Taiwan Yi Zhi. 2019 Oct;118(10):1430–7. https://doi.org/10.1016/j.jfma.2018.12.017. https://pubmed.ncbi.nlm.nih.gov/30612883/

Aydin S, Ozoner B, Sahin S, Alizada O, Comunoglu N, Oz B, et al. A follow-up study on outcomes of endoscopic transsphenoidal approach for acromegaly. Clin Neurol Neurosurg. 2020 Nov;198:106201. https://doi.org/10.1016/j.clineuro.2020.106201. https://pubmed.ncbi.nlm.nih.gov/32927330/

Taghvaei M, Sadrehosseini SM, Ardakani JB, Nakhjavani M, Zeinalizadeh M. Endoscopic Endonasal Approach to the Growth Hormone-Secreting Pituitary Adenomas: Endocrinologic Outcome in 68 Patients. World Neurosurg. 2018 Sep;117:e259–68. https://doi.org/10.1016/j.wneu.2018.06.009. https://pubmed.ncbi.nlm.nih.gov/29902603/

Phan K, Xu J, Reddy R, Kalakoti P, Nanda A, Fairhall J. Endoscopic Endonasal versus Microsurgical Transsphenoidal Approach for Growth Hormone-Secreting Pituitary Adenomas-Systematic Review and Meta-Analysis. World Neurosurg. 2017 Jan;97:398–406. https://doi.org/10.1016/j.wneu.2016.10.029. https://pubmed.ncbi.nlm.nih.gov/27756664/

Downloads

Published

2023-08-31

How to Cite

1.
Aafee A, Khambu B, Jha R, Bista P. Endocrinologic Outcome Following Endonasal Transphenoidal Excision of Growth Hormone Secreting Pituitary Adenomas. Journal of Karnali Academy of Health Sciences [Internet]. 2023Aug.31 [cited 2024May14];6(2). Available from: https://jkahs.org.np/jkahs/index.php/jkahs/article/view/576

Issue

Vol. 6 No. 2 (2023): JKAHS; May-Aug Issue (17)

Section

Original Article

License

Copyright (c) 2023 Ali Aafee, Bikesh Khambu, Rajiv Jha, Prakash Bista

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The author(s) retain the copyright and the full publishing right without restriction under the Creative Commons Attribution 4.0 International License (CC BY 4.0) which allows readers to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material) for any purpose, even commercially, provided the work is properly attributed. (https://creativecommons.org/licenses/by/4.0/).

Author(s) grant the non-exclusive publishing right to the Journal of Karnali Academy of Health Sciences (JKAHS). The publishing rights include the rights to publish, reproduce, distribute, include in indexes or search databases or other media in print or online. The JKAHS may require revisions to the manuscript before acceptance for publication or may choose not to publish it based on the judgement of the editors. Further, JKAHS might retract, withdraw, or publish a correction or other notice after publication, if such publication would be inconsistent with the good publication practices and associated guidelines set forth by the COPE (Committee on Publication Ethics) (https://publicationethics.org/core-practices).

More information about the Creative Commons Attribution 4.0 International License can be found in the webpage of Creative Commons (CC) by following the link provided below:  https://creativecommons.org/licenses/by/4.0/