Abstract
Pituitary adenomas are the most common tumors of the sella turcica. Our objectives here were to describe the transitional phase from microscopic to endoscopic surgery for nonfunctional pituitary adenomas (NFPAs), and to outline the health-related quality of life (HRQoL) and its determinants after treatment of different pituitary adenomas in a recent cohort from a single pituitary center. We retrospectively collected the relevant data for a total of 320 patients who had undergone primary surgery for a newly diagnosed pituitary adenoma during 2000-2010 at Helsinki University Hospital. The first part of our study included 185 consecutive patients who had transsphenoidal surgery for NFPA. These patients were divided into two groups based on the surgical approach: microscopic and endoscopic. Surgical and endocrinological outcomes were assessed at the 3-month follow-up. The second part of our study used a cross-sectional design and comprised all pituitary adenoma types. Each patient alive was sent a questionnaire (the 15D) assessing the HRQoL a mean of 7.4 years after the primary transsphenoidal surgery. One hundred functional pituitary adenoma (FPA) and 137 NFPA patients responded. We then compared HRQoL (15D scores) between patients and a large sample of an age- and gender-standardized Finnish general population. Independent factors influencing the overall HRQoL (mean 15D score) were estimated using multivariate analysis. A good short-term surgical outcome could be achieved during the initial phase of transition from microscopic to endoscopic transsphenoidal surgery for NFPA patients. Our first endoscopic single-center consecutive case series showed a trend towards improved tumor control but the operative time was longer than with the microscopic technique.The effect of NFPA surgery on pituitary function (hypopituitarism) in both surgical groups was neutral. Current multimodal treatment protocols with optimized hormonal replacement therapies enabled normal or at least near-normal overall HRQoL to be achieved in the majority of patients with all types of pituitary adenomas. Hormonal remission rate of FPAs was 91%. However, patients with Cushing s disease and NFPA had clinically and statistically significant impairments of some single dimensions compared with the general population. Comorbidities were strong determinants of compromised overall HRQoL in patients treated for pituitary adenomas.
Original language | English |
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Place of Publication | Helsinki |
Publisher | |
Print ISBNs | 978-951-51-1547-8 |
Electronic ISBNs | 978-951-51-1548-5 |
Publication status | Published - 2015 |
MoE publication type | G5 Doctoral dissertation (article) |
Bibliographical note
M1 - 119 s. + liitteetHelsingin yliopisto
Fields of Science
- Adenoma
- +surgery
- Comorbidity
- Hormone Replacement Therapy
- Microsurgery
- Neoplasm, Residual
- +pathology
- Neuroendoscopy
- +methods
- Pituitary Gland
- +metabolism
- Pituitary Neoplasms
- +complications
- Quality of Life
- Treatment Outcome
- 3124 Neurology and psychiatry
- 3126 Surgery, anesthesiology, intensive care, radiology
- 3121 General medicine, internal medicine and other clinical medicine