Postoperative Prepituitary Gland Dysfunction And Hormone Replacement Treatment Situation In Patients With Pituitary Adenoma

Objective: To retrospectively analyze the situation of prepituitary gland dysfunction and hormone replacement treatment in postoperative patients with pituitary adenoma, and try to provide the reference for patients with postoperative management improvement.Material and method:(1) The subjects: 323 patients with pituitary adenoma who received surgical treatment in Department of nerve tumor surgery in No.1 Hospital of Jilin University from September 2013 to December 2015 were analyzed.(2) Exclusion criteria: Postoperative pathological hint of non-pituitary adenoma;Has a history of radiation therapy, gamma knife treatment;Severe heart and lung, liver, kidney disease and malignant tumor;Surgery is uncertain.(3) Methods-Two steps to collect the data of the patients included in the study: 1 Application of our hospital medical record query system to collect the basic data during the period of hospital, including age, operation time, preoperative MRI enhancement of tumor size, surgical procedure, postoperative pathological type, whether the second operation; 2 through telephone return visit to collect the data of the postoperative patients of general situation(including body mass index, blood pressure, serum sodium, potassium), review of the hormone, hormone replacement therapy.(4) Statistics: SPSS 18.0 were used for statistic analysis. Measurement data with normal distribution were presented in the form of x ±s); count data were pressed in the form of positive number or rate.Result:(1) Out of 323 patients, 80(24.8%) did not accept a follow-up phone call. 243(75.2%) did accept a follow-up call. Among the 243 patients who accepted a follow-up call, 68(27.98%) did not review the related hormone levels after their operations. 175 patients reviewed the related hormone levels after their operations.(2) Among the 243 patients who accepted a follow-up call, 55.97% had pituitary dysfunction. 41.98% had pituitary dysfunction prior to surgery. 13.99% had pituitary dysfunction after the surgery.(3) Of the 102 patients with TSH deficiencies, 26.47% are still being treated with replacement therapy. Of these patients, 16.67% temporarily used medicine after surgery but later stopped. On average, patients used levothyroxine, L-T4, for their replacement treatment therapy. Among the 27 patients undergoing replacement treatment therapy, 15 reviewed the three standards, and 8 were not up to those standards.(4) Of the 53 patients with ACTH deficiencies, 56.60% are still being treated with replacement therapy. 25 patients are using hydrocortisone treatments, 4 are using prednisone treatments, and 1 is using cortisone acetate treatments. The number of patients who temporarily used medicine after surgery but later stopped accounted for 30.19%. 10 of the 30 patients undergoing replacement treatment presented clinical symptoms(2 cases of low blood pressure, 4 cases in which the patient’s BMI was lower than normal, and 4 electrolyte disorders.)(5) Among the 57 patients with Gn H deficiencies, 21.05% accepted replacement treatment therapy. There were 11 male patients who were treated with oral acid testosterone therapy. 1 non-menopausal woman was treated with artificial cycle therapy. Of the 12 patients, only 4 followed up and properly reviewed their hormone situation. They were male, and 100% of those patients did not meet necessary standards.Conclusion:(1) Patient management following the pituitary adenoma surgery is problematic: most patients did not return for a follow up, and most patients did not engage in a comprehensive evaluation of the relevant hormone levels.(2) Patient anterior pituitary function is relatively low after the pituitary adenoma surgery in our hospital.(3) For patients with post-surgery ACTH deficiencies, most were willing to continue with replacement treatment therapy; however, there were some who were unwilling to adhere to the instructions provided by their doctor.(4) For patients with post-surgery TSH deficiencies, there was a problem with perseverance when it came to the replacement treatment therapies. The number of patients which met the necessary standards was low.(5) For patients with post-surgery Gn H deficiencies, some chose to undergo hormone replacement therapy. The replacement results were poor.