Remote results of postoperative treatment of “inactive” pituitary adenoma

Abstract

A retrospective analysis of 77 case histories was carried out in order to evaluate patients’ status in remote period after surgery and analyze the relapses of "inactivepituitary adenomas" (IPA) with consideration for electron microscopy findings. IPA in the analyzed patients was verified by histological, electron-microscopic, and immunohistochemical studies. The patients (39 men and 38 women) were observed for 6-16 years after surgery. Two patients presented with endosellar adenoma, the rest with endoextrasellar adenoma. Adenomectomies were performed through a transcranial access in 69 (90%) patients and through the transnasosphenoid access in 8 (10%). Computer tomographic monitoring in immediate periods after surgery was carried out only in 12% patients, and therefore a more common category "disease relapse" was used for analysis of tumor relapses. Cases when clinical symptoms progressed because of obvious growth of radically or partially removed tumor and repeated treatment (surgery or radiotherapy) was needed were considered as relapses. Relapses occurred in 38 (49%) patients (20 men and 18 women). The highest percentage of relapses occurred in the zero-cell adenoma group (58%), while oncocytomas and undifferentiated adenomas relapsed equally often (46 and 44%, respectively). The mean duration of clinical manifestation of a relapse was virtually the same in all groups (6.9 ± 3.6 years, or 1-16 years). Visual functions improved in 60% cases and pituitary functions normalized in 23%, but the number of patients with hypopituitarism increased by 38%. That is why patients with IPA should be regularly checked up after surgery, as 66% of them develop symptoms of pituitary in sufficiency in remote postoperative period.