Anushka Nair, Sibhi Ganapathy*, Adesh Jagadeesh, Ajay Munireddy, Rajesh Raykar and Shailesh AV Rao

Department of Neurosurgery and Spine Surgery, St. John’s Medical College and Hospital, Bangalore, India

*Corresponding Author: Sibhi Ganapathy, Department of Neurosurgery and Spine Surgery, St. John’s Medical College and Hospital, Bangalore, India.

Received: September 28, 2022; Published: November 29, 2022

Abstract

Introduction: Pituitary adenomas are usually benign and present in two ways – either as an increase in the secretion of hormones or the tumor causing a mass effect on nearby structures. These presentations can include Acromegaly/gigantism, hyperprolactinemia, and Cushing’s syndrome. Transsphenoidal surgery is the first-line treatment for most pituitary adenomas and this study attempts to highlight the extent of functional remission in patients operated on at St John’s Hospital Bangalore for over one year.

Methodology: A retrospective review of patients’ records who have undergone a trans-sphenoidal trans-nasal approach for pituitary tumors from April 2021 to April 2022 was performed. Hormone levels of functional pituitary adenomas were documented pre- and post-operatively to check for remission. All patients also underwent a CT or an MRI postoperatively to assess residual or recurrent disease and for those patients with hormonally active tumors, hormonal studies were also followed up.

Observations: A total of 28 transsphenoidal surgeries were performed during this study period. From a total of 27 pituitary adenomas, 10 (33.3%) were hormonally active, while 18 (66.5%) were non-functioning. The most common presenting complaint was visual field deficits, namely bitemporal hemianopia (76.2%) along with functional presentations like acromegaly (66.6%), Cushing’s disease (22.2%), and hypothyroidism (18.9%). All cases were done under general anesthesia. The average length of hospital stay was 10 days. As is seen in the graphs provided, the post-operative measurements of functional parameters showed a significant drop when complete excision of the lesion was performed, with an average drop of 91% in growth hormone levels, 95.8% in cortisol levels, and 78% in TSH. The most common indication for longer hospitalization was diabetes insipidus which required extended monitoring and correction in liaison with the Endocrinology department.

Conclusion: The Transnasal-Transsphenoidal (TNTS) hypophysectomy approach represents the basic approach by which most pituitary adenomas are surgically resected. This report suggests and demonstrates that this procedure can result in improved rates of complete tumor removal, functional remission of hormonal parameters, and a reduced rate of complications.

Keywords:Hormonal Remission; TNTS; Pituitary Adenomas

References

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4. Cardinal T., et al. “Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly”. Neurosurgical Focus FOC6 (2020): E10.
5. Melmed S., et al. “Current treatment guidelines for acromegaly”. The Journal of Clinical Endocrinology and Metabolism 8 (1998): 2646-2652.

Citation

Citation: Sibhi Ganapathy., et al. “Hormonal Remission Post TNTS Resection of Functional Pituitary Adenomas in a Tertiary Care Centre in South India - An Institutional Experience". Acta Scientific Neurology 5.12 (2022): 98-102.

Copyright

Copyright: © 2022 Sibhi Ganapathy., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.