Sinonasal Outcomes following Pituitary Surgery for Acromegaly

Introduction: Acromegalics present with a wide range of otolaryngic symptoms, including changes in facial appearance, obstructive sleep apnea, voice disturbances, and chronic rhinosinusitis. Treatment, including transnasal-transsphenoidal resection of the offending pituitary adenoma, offers concomitant therapy for chronic sinonasal disease, but harbors the potential to create or exacerbate sinonasal symptoms. The 22-element sinonasal outcome test (SNOT-22) is a validated instrument that allows for quantification of nasal symptoms, with higher scores corresponding to more severe symptoms. In this study, we evaluate SNOT-22 scores both preceding and following surgical therapy for acromegaly.

Study Design: Case series.

Methods: Patients diagnosed with acromegaly at a tertiary care center who underwent surgical resection of a growth-hormone secreting pituitary adenoma between August 2010 and September 2013 were asked to complete SNOT-22 surveys before and after endoscopic transnasal-transsphenoidal surgery. Patients who completed at least one preoperative and/or postoperative SNOT-22 survey were included in the study. A student's t-test was used to compare preoperative and postoperative SNOT-22 scores.

Results: There were 28 patients who underwent pituitary surgery for acromegaly during this time period. Ten patients (seven male, three female) met inclusion criteria. Mean age was 46 (range, 22 to 64). Average duration of follow-up after surgery was 7.4 months (range, 0.7 to 29.5 months). Preoperative SNOT-22 scores demonstrated a mean of 30.0 (range, 1 to 84), and postoperative scores demonstrated a mean of 25.8 (range, 5 to 62). Not surprisingly, patients' sinonasal symptoms worsened in the immediate post-operative period.

Conclusion: Acromegalics present with assorted otolaryngic complaints, including chronic rhinosinusitis. Surgical therapy may alleviate sinonasal symptoms in patients with existing sinus disease, but in asymptomatic patients, transnasal-transsphenoidal surgery may lead to symptoms mimicking those of chronic rhinosinusitis in the early post-operative period. Longer-term follow-up will be needed to determine whether sinonasal symptoms improve in acromegalics following surgical resection of pituitary adenoma.