Serial Re-Expansion of Pituitary Gland Is Associated with Endocrinologic Recovery

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• 作者：Kyung Rae Cho¹ ; Sang Duk Hong² ; Kyu Yeon Hur³ ; Sung Tae Kim⁴ ; Ho Jun Seol¹ ; Jung-Il Lee¹ ; Doo-Sik Kong¹ ; ^{doosik.kong@samsung.com" class="auth_mail" title="E-mail the corresponding author} ; ^{neurokong@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Do-Hyun Nam¹ ; ⁵ ; ^{nsnam@skku.edu" class="auth_mail" title="E-mail the corresponding author} ; ^{biovictory2@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Endoscopic surgery ; Hormone replacement therapy ; Pituitary adenoma ; Pituitary gland ; Trans-sphenoidal approach
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：90
• 期：Complete
• 页码：496-503
• 全文大小：1550 K

文摘

Minimizing pituitary dysfunction by preservation of the normal pituitary gland has a significant clinical impact on patient outcome after pituitary surgery. This study aimed to determine whether re-expansion of the healthy gland after surgery was related to endocrinologic outcome.

Methods

From January 2012 to July 2014, 112 patients were eligible for this retrospective study. Magnetic resonance imaging with dynamic contrast enhancement done2 days and 3 months before and after surgery was evaluated to assess the tumor and normal pituitary gland. We assessed the size of the pituitary gland and evaluated the relationship with endocrinologic outcome.

Results

The mean preoperative size of the gland was 3.86 mm, within 2 days after surgery it was 5.50 mm and 3 months after surgery it was 7.17 mm. Preoperatively patients were grouped based on their requirement of hormone replacement. Patients who required hormone replacement therapy before surgery and did not recover from hormonal insufficiency were classified as group 1 (26 patients), those who recovered from preoperative hormonal insufficiency and discontinued hormone replacement after surgery were classified as group 2 (17 patients), and those who showed hormonally normal status and did not need hormone replacement before and after surgery were in group 3 (68 patients). In group 1, the size of the gland expanded 1.24 times within postoperative 2 days but had no increase after 3 months (1.25 mm) (P = 0.716). Group 2 showed a 1.30 times larger gland within postoperative 2 days and 2.37 times at 3 months follow-up (P = 0.001). Group 3 showed 1.62 times larger gland at postoperative day 2 and 2.1 times larger at the 3-month follow-up.

Conclusions

Serial re-expansion of the healthy pituitary gland at the 3-month follow-up magnetic resonance imaging can predict the endocrinologic recovery.