Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute

Abstract

Objective Biochemical remission rates of endoscopic endonasal transsphenoidal surgery (EETS) and its associated predictive factors were evaluated in patients with somatotrophin pituitary adenomas.

Methods The patients who underwent EETS in Jinling Hospital were identified between 2011 and 2020. The surgeons' experience, preoperative insulin-like growth factor 1 (IGF-1), basal growth hormone (GH) levels, nadir GH levels, and the tumor characteristics were analyzed for their relationships with endocrine outcomes. Total 98 patients were included for single factor analysis and regression analysis. They were divided into three groups according to the admission chronologic order.

Results The overall remission rate of the patients was 57% (56/98) for all the patients over 10 years. In the single factor analysis, we found that the tumor size, cavernous invasion, and sellar invasion were valuable to predict the endocrine outcome after surgery. As for the suprasellar invasion, no significant difference was found between the noninvasive group and the invasive group. The preoperative IGF-1 level (p = 0.166), basal GH level (p = 0.001), and nadir GH level (p = 0.004) were also different between the remission group and the nonremission group in the single factor analysis. The logistic regression analysis indicated that the preoperative nadir GH (odds ratio = 0.930, 95% confidence interval = 0.891–0.972, p = 0.001) was a significant predictor for the endocrine outcomes after surgery.

Conclusion The surgeons' experience is an important factor that can affect the patients' endocrine outcomes after surgery. The macroadenomas with lateral invasion are more difficult to cure. Patients with higher preoperative nadir GH levels are less likely to achieve remission.

Keywords

pituitary adenoma - acromegaly - growth hormone - cavernous sinus - invasion - Knosp - endoscopic - transsphenoidal surgery

Ethical Approval and Consent to Participate

All patients provided written informed consent. The Institutional Review Board at Jinling Hospital approved the study.

Consent for Publication

The authors declare that the manuscript has not been submitted for publication elsewhere, in whole or in part, in any language. All authors have contributed to, read, and approved the enclosed manuscript.

Authors' Contributions

Y.G., Q.D., Z.C., J.Z., Z.L., C.D., F.Y., X.Z., A.A., J.Y., C.T., and C.M. all contributed to the review of relevant literature, writing, editing, and/or revising of the manuscript.

^* These authors contributed equally to this work and share first authorship.

Publikationsverlauf

Eingereicht: 08. Februar 2023

Angenommen: 22. April 2023

Accepted Manuscript online:
26. April 2023

Artikel online veröffentlicht:
30. Mai 2023

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