Evaluating Endocrine Changes and Surgical Complications following Endoscopic Transsphenoidal Excision of Pituitary Macroadenomas

Abstract

Background: Intracranial lesions arising in the region of the pituitary gland are relatively common. Pituitary adenomas (PAs) with extensive suprasellar extension are a challenge for therapeutics. For evaluation of PAs, the clinical and biochemical assessment stands as the cornerstone. The easy access of advanced neuroimaging has increased the sensitivity of detection of smaller lesions in the pituitary region. Many treatment modalities have developed so far undergoing numerous refinements over the past 100 years. Transsphenoidal surgery is considered relatively safe and widely being practiced. Materials and Methods: This was a hospital-based cross-sectional study conducted in national neurosurgical referral center, Bir hospital, Kathmandu, Nepal, on 38 patients who underwent endoscopic endonasal transsphenoidal pituitary gland excision for pituitary macroadenomas. Results: The mean serum prolactin (PRL) level was observed as 706.57 ± 1196.09 ng/mL preoperatively and 42.91 ± 109.1 ng/mL postoperatively. The mean value of growth hormone (GH) was observed as 13.34 ± 12.59 ng/mL preoperatively which was reduced to 6.48 ± 6.90 ng/mL postoperatively. Postoperatively, neurogenic diabetes insipidus was observed in 12 patients. 5 patients had cerebrospinal fluid (CSF) leak postoperatively. Meningitis was seen in 2 cases. Conclusion: Endoscopic endonasal transsphenoidal pituitary gland excision is an effective surgical modality for the management of pituitary macroadenomas which led to significant improvements in endocrine function postoperatively. The marked decrease in serum PRL and GH levels postoperatively shows the efficacy of this surgery in treating hormone-secreting adenomas. Complications such as neurogenic diabetes insipidus, CSF leaks, and meningitis should be an important consideration in the post-operative care even though they are less frequent.