Four Years Survey Of Post Surgical Patients With Pituitary Adenoma

ObjectivesWe report the clinical characteristic and surgical outcome in four years of retrospective study of patients with pituitary adenomas who attended surgical treatment from 2004 january to 2008 april,and the survey result among them for 4 years.MethodsThe retrospective clinical study found 561 patients in four years analysis and the pituitary adenomas account for 10.66±2.93%of the intracranial surgery.Among 561 patients,338 females and 223 males,the mean age were 44.02 years old.The main presenting symptoms were acuity deficiency 51.51%,headaches 34.76%, amenorrhea 22.64%,galactorrhea 13.9%,acromegaly 11.76%.The preoperative hormonal examinations showed 52.84%of hyper prolactinemia,18.23%of hyper serum HGH,25.4%hyper serum ACTH,5.9%hyper cortisolemia,3.9%of hyper serum TSH.According to Hardy's classification,microadenoma accounted for 3.3%, intrasellar macroadenomas 38.2%,extrasellar macroadenomas 48.7%,and giants adenomas 9.31%.For the surgical approaches,transnazal transsphenoidal took 77% and transcranial 23%.The pituitary types were 53.47%for the non-functionning adenoma,19.78%PRL,9.62%GH,4.63%ACTH,5.52%for the mixed adenomas, 1.24%of invasive and 0.39%of carcinomas.The main complications were the hydroelectrolytics instability 22.10%,diabetes 11.59%and diabetes insipidus 4.46%. The surgical cure rate reached 36.1%in Acromegaly,41.25%in Acth,16.54%in Cortisol and 28.62%in PRL.With 0.71%of mortality and recurrence rate of 5.35%.We found 236 patients for the follow up.7/236(7.20%) of patients attended the radiotherapy treatment when 96%of the patient had a microscopic potential dural invasion. Conclusion.Our study corroborates the previous results that the pituitary adenoma is principally a benign tumor of young adults and more older people's disease,with high female tendancy.The long duration of the symptoms in the patients in our study complicated the surgical treatment,finding more macroadenomas in all types of adenomas.We suggest to reconsider the serological value suspecting the pituitary adenomas,by 1200 mIU/L(P.000) for prolactinomas,26 mg/ml(P.000) for somatotroph adenoma.But no significant hormonal value in ACTH or CORT for corticotroph adenomas lead us to reconsider the diagnosis of corticotroph adenoma.The choice of the approach depends on the tumor size,the localisation,the nature of the tumor tissue and the general condition of the patient.Compared to the transcranial approach,the transsphenoidal approach took less time during operation, was less invasive,less hospital duration,less postoperative complications,less expenditures and no external scarification.It gave better results for the microadenomas and macroadenomas surgery but had a lot of limits for patients with giant adenomas who still needed craniotomy surgery.The surgical treatment by the transsphenoidal approach gave low mortality and morbidity compare to the transcranial approach.Despite the total excision,adjunctive postoperative radiotherapy coverage did not help for the long term remission of invasive intrasellar and extrasellar adenomas.