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Marques P, Sagarribay A, Tortosa F, Neto L, Tavares Ferreira J, Subtil J, Palha A, Dias D, Sapinho I. Multidisciplinary Team Care in Pituitary Tumours. Cancers (Basel) 2024; 16:950. [PMID: 38473312 DOI: 10.3390/cancers16050950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/05/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The optimal care for patients with pituitary tumours is best provided in a multidisciplinary and collaborative environment, which requires the contribution of multiple medical specialties working together. The benefits and advantages of the pituitary multidisciplinary team (MDT) are broad, and all relevant international consensus and guidelines in the field recommend that patients with pituitary tumours should always be managed in a MDT. Endocrinologists and neurosurgeons are normally the leading specialties within the pituitary MDT, supported by many other specialties with significant contributions to the diagnosis and management of pituitary tumours, including neuropathology, neuroradiology, neuro-ophthalmology, and otorhinolaryngology, among others. Here, we review the literature concerning the concepts of Pituitary MDT/Pituitary Tumour Centre of Excellence (PTCOE) in terms of their mission, goals, benefits, structure, proposed models of function, and barriers, and we also provide the views of different specialists involved in our Pituitary MDT.
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Affiliation(s)
- Pedro Marques
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
- Faculty of Medicine, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Amets Sagarribay
- Pituitary Tumor Unit, Neurosurgery Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Francisco Tortosa
- Pituitary Tumor Unit, Pathology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Lia Neto
- Pituitary Tumor Unit, Radiology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Joana Tavares Ferreira
- Pituitary Tumor Unit, Ophthalmology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - João Subtil
- Pituitary Tumor Unit, Otorhinolaryngology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Ana Palha
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Daniela Dias
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
| | - Inês Sapinho
- Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, 1998-018 Lisbon, Portugal
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Caulley L, Quinn JG, Doyle MA, Alkherayf F, Metzendorf MI, Kilty S, Hunink MGM. Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults. Cochrane Database Syst Rev 2024; 2:CD013561. [PMID: 38318883 PMCID: PMC10845214 DOI: 10.1002/14651858.cd013561.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Growth hormone (GH)-secreting pituitary adenoma is a severe endocrine disease. Surgery is the currently recommended primary therapy for patients with GH-secreting tumours. However, non-surgical therapy (pharmacological therapy and radiation therapy) may be performed as primary therapy or may improve surgical outcomes. OBJECTIVES To assess the effects of surgical and non-surgical interventions for primary and salvage treatment of GH-secreting pituitary adenomas in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases was 1 August 2022. We did not apply any language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of more than 12 weeks' duration, reporting on surgical, pharmacological, radiation, and combination interventions for GH-secreting pituitary adenomas in any healthcare setting. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance, screened for inclusion, completed data extraction, and performed a risk of bias assessment. We assessed studies for overall certainty of the evidence using GRADE. We estimated treatment effects using random-effects meta-analysis. We expressed results as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) for continuous outcomes, or in descriptive format when meta-analysis was not possible. MAIN RESULTS We included eight RCTs that evaluated 445 adults with GH-secreting pituitary adenomas. Four studies reported that they included participants with macroadenomas, one study included a small number of participants with microadenomas. The remaining studies did not specify tumour subtypes. Studies evaluated surgical therapy alone, pharmacological therapy alone, or combination surgical and pharmacological therapy. Methodological quality varied, with many studies providing insufficient information to compare treatment strategies or accurately judge the risk of bias. We identified two main comparisons, surgery alone versus pharmacological therapy alone, and surgery alone versus pharmacological therapy and surgery combined. Surgical therapy alone versus pharmacological therapy alone Three studies with a total of 164 randomised participants investigated this comparison. Only one study narratively described hyperglycaemia as a disease-related complication. All three studies reported adverse events, yet only one study reported numbers separately for the intervention arms; none of the 11 participants were observed to develop gallbladder stones or sludge on ultrasonography following surgery, while five of 11 participants experienced any biliary problems following pharmacological therapy (RR 0.09, 95% CI 0.01 to 1.47; 1 study, 22 participants; very low-certainty evidence). Health-related quality of life was reported to improve similarly in both intervention arms during follow-up. Surgery alone compared to pharmacological therapy alone may slightly increase the biochemical remission rate from 12 weeks to one year after intervention, but the evidence is very uncertain; 36/78 participants in the surgery-alone group versus 15/66 in the pharmacological therapy group showed biochemical remission. The need for additional surgery or non-surgical therapy for recurrent or persistent disease was described for single study arms only. Surgical therapy alone versus preoperative pharmacological therapy and surgery Five studies with a total of 281 randomised participants provided data for this comparison. Preoperative pharmacological therapy and surgery may have little to no effect on the disease-related complication of a difficult intubation (requiring postponement of surgery) compared to surgery alone, but the evidence is very uncertain (RR 2.00, 95% CI 0.19 to 21.34; 1 study, 98 participants; very low-certainty evidence). Surgery alone may have little to no effect on (transient and persistent) adverse events when compared to preoperative pharmacological therapy and surgery, but again, the evidence is very uncertain (RR 1.23, 95% CI 0.75 to 2.03; 5 studies, 267 participants; very low-certainty evidence). Concerning biochemical remission, surgery alone compared to preoperative pharmacological therapy and surgery may not increase remission rates up until 16 weeks after surgery; 23 of 134 participants in the surgery-alone group versus 51 of 133 in the preoperative pharmacological therapy and surgery group showed biochemical remission. Furthermore, the very low-certainty evidence did not suggest benefit or detriment of preoperative pharmacological therapy and surgery compared to surgery alone for the outcomes 'requiring additional surgery' (RR 0.48, 95% CI 0.05 to 5.06; 1 study, 61 participants; very low-certainty evidence) or 'non-surgical therapy for recurrent or persistent disease' (RR 1.22, 95% CI 0.65 to 2.28; 2 studies, 100 participants; very low-certainty evidence). None of the included studies measured health-related quality of life. None of the eight included studies measured disease recurrence or socioeconomic effects. While three of the eight studies reported no deaths to have occurred, one study mentioned that overall, two participants had died within five years of the start of the study. AUTHORS' CONCLUSIONS Within the context of GH-secreting pituitary adenomas, patient-relevant outcomes, such as disease-related complications, adverse events and disease recurrence were not, or only sparsely, reported. When reported, we found that surgery may have little or no effect on the outcomes compared to the comparator treatment. The current evidence is limited by the small number of included studies, as well as the unclear risk of bias in most studies. The high uncertainty of evidence significantly limits the applicability of our findings to clinical practice. Detailed reporting on the burden of recurrent disease is an important knowledge gap to be evaluated in future research studies. It is also crucial that future studies in this area are designed to report on outcomes by tumour subtype (that is, macroadenomas versus microadenomas) so that future subgroup analyses can be conducted. More rigorous and larger studies, powered to address these research questions, are required to assess the merits of neoadjuvant pharmacological therapy or first-line pharmacotherapy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Institut for Klinisk Medicin, Aarhus University, Aarhus, Denmark
| | - Jason G Quinn
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Canada
| | - Mary-Anne Doyle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
| | - Fahad Alkherayf
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine University, Düsseldorf, Germany
| | - Shaun Kilty
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - M G Myriam Hunink
- Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Boston, Massachussetts, USA
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Papadimitriou E, Chatzellis E, Dimitriadi A, Kaltsas GA, Theocharis S, Alexandraki KI. Prognostic Biomarkers in Pituitary Tumours: A Systematic Review. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:42-53. [PMID: 38187082 PMCID: PMC10769480 DOI: 10.17925/ee.2023.19.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/07/2023] [Indexed: 01/09/2024]
Abstract
Pituitary tumours (PTs) are the second most common intracranial tumour. Although the majority show benign behaviour, they may exert aggressive behaviour and can be resistant to treatment. The aim of this review is to report the recently identified biomarkers that might have possible prognostic value. Studies evaluating potentially prognostic biomarkers or a therapeutic target in invasive/recurrent PTs compared with either non-invasive or non-recurrent PTs or normal pituitaries are included in this review. In the 28 included studies, more than 911 PTs were evaluated. A systematic search identified the expression of a number of biomarkers that may be positively correlated with disease recurrence or invasion in PT, grouped according to role: (1) insensitivity to anti-growth signals: minichromosome maintenance protein 7; (2) evasion of the immune system: cyclooxygenase 2, arginase 1, programmed cell death protein 1 (PD-1)/programmed death ligand 2, cluster of differentiation (CD) 80/CD86; (3) sustained angiogenesis: endothelial cell-specific molecule, fibroblast growth factor receptor, matrix metalloproteinase 9, pituitary tumour transforming gene; (4) self-sufficiency in growth signals: epidermal growth factor receptor; and (5) tissue invasion: matrix metalloproteinase 9, fascin protein. Biomarkers with a negative correlation with disease recurrence or invasion include: (1) insensitivity to anti-growth signals: transforming growth factor β1, Smad proteins; (2) sustained angiogenesis: tissue inhibitor of metalloproteinase 1; (3) tissue invasion: Wnt inhibitory factor 1; and (4) miscellaneous: co-expression of glial fibrillary acidic protein and cytokeratin, and oestrogen receptors α36 and α66. PD-1/programmed cell death ligand 1 showed no clear association with invasion or recurrence, while cyclin A, cytotoxic T lymphocyte-associated protein 4, S100 protein, ephrin receptor, galectin-3 , neural cell adhesion molecule, protein tyrosine phosphatase 4A3 and steroidogenic factor 1 had no association with invasion or recurrence of PT. With the aim to develop a more personalized approach to the treatment of PT, and because of the limited number of molecular targets currently studied in the context of recurrent PT and invasion, a better understanding of the most relevant of these biomarkers by well-d esigned interventional studies will lead to a better understanding of the molecular profile of PT. This should also meet the increased need of treatable molecular targets.
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Affiliation(s)
- Eirini Papadimitriou
- First Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Chatzellis
- Endocrinology Diabetes and Metabolism Department, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | | | - Gregory A Kaltsas
- First Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Wahba AJ, Cromwell DA, Hutchinson PJ, Mathew RK, Phillips N. Assessing national patterns and outcomes of pituitary surgery: is hospital administrative data good enough? Br J Neurosurg 2023; 37:1135-1142. [PMID: 36727284 DOI: 10.1080/02688697.2023.2170982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Patterns of surgical care, outcomes, and quality of care can be assessed using hospital administrative databases but this requires accurate and complete data. The aim of this study was to explore whether the quality of hospital administrative data was sufficient to assess pituitary surgery practice in England. METHODS The study analysed Hospital Episode Statistics (HES) data from April 2013 to March 2018 on all adult patients undergoing pituitary surgery in England. A series of data quality indicators examined the attribution of cases to consultants, the coding of sellar and parasellar lesions, associated endocrine and visual disorders, and surgical procedures. Differences in data quality over time and between neurosurgical units were examined. RESULTS A total of 5613 records describing pituitary procedures were identified. Overall, 97.3% had a diagnostic code for the tumour or lesion treated, with 29.7% (n = 1669) and 17.8% (n = 1000) describing endocrine and visual disorders, respectively. There was a significant reduction from the first to the fifth year in records that only contained a pituitary tumour code (63.7%-47.0%, p < .001). The use of procedure codes that attracted the highest tariff increased over time (66.4%-82.4%, p < .001). Patterns of coding varied widely between the 24 neurosurgical units. CONCLUSION The quality of HES data on pituitary surgery has improved over time but there is wide variation in the quality of data between neurosurgical units. Research studies and quality improvement programmes using these data need to check it is of sufficient quality to not invalidate their results.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Research, Royal College of Surgeons of England, London, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Caulley L, Whelan J, Khoury M, Mavedatnia D, Sahlollbey N, Amrani L, Eid A, Doyle MA, Malcolm J, Alkherayf F, Ramsay T, Moher D, Johnson-Obaseki S, Schramm D, Hunink MGM, Kilty SJ. Post-operative surveillance for somatotroph, lactotroph and non-functional pituitary adenomas after curative resection: a systematic review. Pituitary 2023; 26:73-93. [PMID: 36422846 DOI: 10.1007/s11102-022-01289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
CONTEXT Pituitary tumors are the third most common brain tumor and yet there is no standardization of the surveillance schedule and assessment modalities after transsphenoidal surgery. EVIDENCE ACQUISITION OVID, EMBASE and the Cochrane Library databases were systematically screened from database inception to March 5, 2020. Inclusion and exclusion criteria were designed to capture studies examining detection of pituitary adenoma recurrence in patients 18 years of age and older following surgical resection with curative intent. EVIDENCE SYNTHESIS A total of 7936 abstracts were screened, with 812 articles reviewed in full text and 77 meeting inclusion criteria for data extraction. A pooled analysis demonstrated recurrence rates at 1 year, 5 years and 10 years for non-functioning pituitary adenomas (NFPA; N = 3533 participants) were 1%, 17%, and 33%, for prolactin-secreting adenomas (PSPA; N = 1295) were 6%, 21%, and 28%, and for growth-hormone pituitary adenomas (GHPA; N = 1257) were 3%, 8% and 13%, respectively. Rates of recurrence prior to 1 year were 0% for NFPA, 1-2% for PSPA and 0% for GHPA. The mean time to disease recurrence for NFPA, PSPA and GHPA were 4.25, 2.52 and 4.18 years, respectively. CONCLUSIONS This comprehensive review of the literature quantified the recurrence rates for commonly observed pituitary adenomas after transsphenoidal surgical resection with curative intent. Our findings suggest that surveillance within 1 year may be of low yield. Further clinical trials and cohort studies investigating cost-effectiveness of surveillance schedules and impact on quality of life of patients under surveillance will provide further insight to optimize follow-up.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Jonathan Whelan
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Michel Khoury
- Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Canada
| | - Dorsa Mavedatnia
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Nick Sahlollbey
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Lisa Amrani
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Anas Eid
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Mary-Anne Doyle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
| | - Janine Malcolm
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Fahad Alkherayf
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Center for Journalology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Schramm
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G M Hunink
- Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shaun J Kilty
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Caulley L, Krijkamp E, Doyle MA, Thavorn K, Alkherayf F, Sahlollbey N, Dong SX, Quinn J, Johnson-Obaseki S, Schramm D, Kilty SJ, Hunink MGM. Cost-effectiveness of direct surgery versus preoperative octreotide therapy for growth-hormone secreting pituitary adenomas. Pituitary 2022; 25:868-881. [PMID: 36030360 PMCID: PMC9675692 DOI: 10.1007/s11102-022-01270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The objective of this study was to compare the cost-effectiveness of preoperative octreotide therapy followed by surgery versus the standard treatment modality for growth-hormone secreting pituitary adenomas, direct surgery (that is, surgery without preoperative treatment) from a public third-party payer perspective. METHODS We developed an individual-level state-transition microsimulation model to simulate costs and outcomes associated with preoperative octreotide therapy followed by surgery and direct surgery for patients with growth-hormone secreting pituitary adenomas. Transition probabilities, utilities, and costs were estimated from recent published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs [2020 United States (US) Dollars], quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULTS Under base case assumptions, direct surgery was found to be the dominant strategy as it yielded lower costs and greater health effects (QALYs) compared to preoperative octreotide strategy in the second-order Monte Carlo microsimulation. The ICER was most sensitive to probability of remission following primary therapy and duration of preoperative octreotide therapy. Accounting for joint parameter uncertainty, direct surgery had a higher probability of demonstrating a cost-effective profile compared to preoperative octreotide treatment at 77% compared to 23%, respectively. CONCLUSIONS Using standard benchmarks for cost-effectiveness in the US ($100,000/QALY), preoperative octreotide therapy followed by surgery may not be cost-effective compared to direct surgery for patients with growth-hormone secreting pituitary adenomas but the result is highly sensitive to initial treatment failure and duration of preoperative treatment.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Eline Krijkamp
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mary-Anne Doyle
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Fahad Alkherayf
- The Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Nick Sahlollbey
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Selina X Dong
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Jason Quinn
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - David Schramm
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Shaun J Kilty
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Myriam G M Hunink
- Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
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Ghiam MK, Ali IA, Dable CL, Ayala AR, Kargi AY, Komotar RJ, Levine CG, Sargi Z. Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care. J Neurol Surg B Skull Base 2022; 83:626-634. [PMID: 36393882 PMCID: PMC9653288 DOI: 10.1055/a-1920-0758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/29/2022] [Indexed: 10/16/2022] Open
Abstract
Background Thirty-day unplanned readmission following endoscopic transsphenoidal pituitary surgery (ETPS) occurs in up to 14% of patients. Delayed hyponatremia is one of the most common causes, accounting for 30% of readmissions and often occurs within 1 week of surgery. The authors' prior retrospective review identified endocrinology follow-up as protective factor. Objectives Implementation of a multidisciplinary postoperative care (POC) pathway: (1) to reduce 30-day hospital readmissions following ETPS and (2) improve inpatient and outpatient coordination of care with endocrinologist. Methods This study is a single institution temporal cohort study of patients prior to (control cohort) and after implementation of the POC pathway (intervention cohort). The POC pathway utilized postdischarge 1 to 1.5 L/d fluid restriction, postoperative days 5 to 7 serum sodium, and endocrinology follow-up within 1 week of discharge to stratify patients into tiered hyponatremia regimens. Results A total of 542 patients were included in the study, 409 (75%) in the control cohort and 133 (25%) in the intervention cohort. All-cause readmission was significantly reduced following implementation of the POC pathway (14 vs. 6%, p = 0.015). Coordination with endocrinologist significantly increased in the inpatient (96 vs. 83%, p < 0.001) and outpatient (77 vs. 68%, p = 0.042) settings. Patients who were not in the POC pathway had the highest risk of readmission (odds ratio: 2.5; 95% confidence interval: 1.1-5.5). Conclusion A multidisciplinary POC pathway incorporating endocrinologist in conjunction with postdischarge weight-based fluid restriction and postoperative serum sodium levels can safely be used to reduce 30-day readmissions following ETPS.
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Affiliation(s)
- Michael K. Ghiam
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ibrahim A. Ali
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Cortney L. Dable
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alejandro R. Ayala
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Atil Y. Kargi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ricardo J. Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Corinna G. Levine
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
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Sun X, Huo L, Wang X, Zhang C, Zhao A. Comprehensive clinical analysis of patients with primary malignant tumor of pituitary gland: A population-based study. Front Surg 2022; 9:933168. [PMID: 36329977 PMCID: PMC9624243 DOI: 10.3389/fsurg.2022.933168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/21/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aims to perform a comprehensive clinical analysis of patients with primary malignant pituitary tumors (PMPT) that involves incidence, demographics, treatments, long-term survival, and death causes. MATERIALS AND METHODS Patients with PMPT were identified from registries of the Surveillance, Epidemiology, and End Results (SEER) database. Frequencies and average annual age-adjusted rate (AAR) were calculated for incidence trend analyses using Join-point regression. Univariate and multivariate Cox regression analyses were conducted to identify potential prognostic factors associated with patients' survival outcomes. Using the Kaplan-Meier method and log-rank test, survival curves were plotted and compared, respectively. Propensity score matching (PSM) was performed to balance baseline characteristics. RESULTS The AAR for PMPT was 0.233 (95%CI: 0.205-0.264) per 1,000,000 using nine SEER registries from 1975 to 2017. The incidence trend has declined over years but without significance (-1.04% per year, P = 0.10). Besides, older age may indicate a higher incidence rate for both pediatric and adult patients. From 18 SEER registries, a total of 501 PMPT patients were also identified. Univariate and multivariate Cox regression showed age, sex, tumor extent, and marital status were independent prognostic factors for malignant pituitary tumors. Via PSM, we found that patients who received surgery, radiotherapy, and chemotherapy did not demonstrate significantly different survival than those who did not. CONCLUSION This study first conducts a comprehensive clinical analysis of patients with PMPT and provides guide effects on future study designs. More studies should be conducted to focus on its characteristics and therapy.
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Affiliation(s)
- Xu Sun
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Lanqing Huo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Xin Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunlan Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Ailin Zhao Chunlan Zhang
| | - Ailin Zhao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China,Correspondence: Ailin Zhao Chunlan Zhang
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Alahmari M, Alkherayf F, Lasso A, Banaz F, Mohajeri S, Masoudian P, Lamothe A, Agbi C, Caulley L, Alshardan M, Kilty S. Recovery of Cranial Nerve Deficits in Patients Presenting with Pituitary Apoplexy: A Case Series. Skull Base Surg 2022; 83:e1-e6. [DOI: 10.1055/s-0040-1722668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Background Pituitary apoplexy (PA) is a rare complication of pituitary tumors that can present with a myriad of symptoms, including sudden onset cranial nerve deficits. After patient stabilization and hormone replacement, surgical decompression is often recommended. The timing of surgical decompression remains controversial. In this case series, we describe our institutional experience pertaining to the cranial nerve recovery in patients who underwent endoscopic endonasal transsphenoidal (EETS) surgery for PA while evaluating outcome based on tumor stage using the suprasellar infrasellar parasellar anterior posterior (SIPAP) classification.
Design Present study is a single-institution retrospective cohort.
Methods A retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by trained personnel to identify cases of PA treated using the EETS approach. Baseline characteristics, tumor type, endocrine data, and SIPAP classification based on preoperative magnetic resonance imaging (MRI) and operation characteristics were extracted from medical records. Postoperative results were extracted for the duration of the follow-up period available for each patient.
Results Fifteen cases of PA were identified. Patient follow-up period was a mean of 30 months. The cranial nerve deficits present at admission were visual deficit (33%); unilateral third nerve palsy (47%) and unilateral sixth nerve palsy (27%). No fourth nerve palsies were observed. Following EETS, 60% of patients with preoperative visual deficit had normal visual fields. For those with third and sixth nerve palsies preoperatively, 43 and 75%, respectively, had return to normal function postoperatively. SIPAP tumor characteristics were not related to postoperative cranial nerve recovery.
Conclusion In this series of surgically treated patients with pituitary apoplexy, all cranial nerve deficits normalized or improved following surgery. The tumor SIPAP classification was not associated with patient outcome. Though in a small series, the presented results suggest surgical treatment is beneficial for these patients.
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Affiliation(s)
- Mohammed Alahmari
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Fahad Alkherayf
- Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Andrea Lasso
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Fatmahalzahra Banaz
- Department of Otolaryngology Head and Neck Surgery, King Abdulaziz Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Sepideh Mohajeri
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Pourya Masoudian
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Andre Lamothe
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles Agbi
- Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Mohammad Alshardan
- Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shaun Kilty
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
- Dr. S. Kilty Medicine Prof. Corp., Ottawa, Ontario, Canada
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10
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Ghaffari-Rafi A, Mehdizadeh R, Ghaffari-Rafi S, Castillo JA, Rodriguez-Beato FY, Leon-Rojas J. Demographic and socioeconomic disparities of pituitary adenomas and carcinomas in the United States. J Clin Neurosci 2022; 98:96-103. [PMID: 35151063 DOI: 10.1016/j.jocn.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Growth of some pituitary tumors is driven by hormones which vary in concentration along the lines of patient socioeconomic status. Thus, pituitary tumors may exhibit disparities in incidence upon stratification by socioeconomic variables. Exploring for these disparities could provide direction in tumor etiology elucidation and identification of healthcare inequalities. METHODS To investigate pituitary adenoma and carcinoma incidence (per 100,000) with respect to sex, age, income, residence, and race/ethnicity, we searched the largest American administrative dataset (1997-2016), the National (Nationwide) Inpatient Sample (NIS), which surveys 20% of United States (US) discharges. RESULTS Annual national incidence was 2.80 for adenomas and 0.046 for carcinomas. For adenomas, males had an incidence of 2.63, similar (p = 0.17) to females at 2.78; likewise, for carcinomas, males had a statistically equivalent (p = 0.24) incidence at 0.051 to females at 0.041. Amongst age groups, for adenomas incidence progressively rose, peaking 65-84 years old (6.12), before declining. For adenomas and carcinomas respectively, patients with low income had an incidence of 2.66 and 0.044, similar (p = 0.11; p = 0.72) to the 3.01 and 0.041 of middle/high income patients. Incidence was greatest for adenomas amongst urban centers (3.47), followed by rural (3.16) and suburban (3.01) communities. Examining race/ethnicity (p = 0.0000016), for adenomas, incidences amongst Blacks, Asian/Pacific Islanders, Hispanics, and Whites were as follows, respectively: 3.64, 2.57, 2.54, 2.44. Annually, incidence for adenomas was increasing (τ = 0.63, p = 0.00021), but decreasing (τ = -0.60, p = 0.00085) for carcinomas. Specifically, for carcinomas incidence was only decreasing for females and the middle/high income. CONCLUSION In the US, time-enduring healthcare disparities were identified for pituitary adenomas and carcinomas, against the background of sociodemographic strata. For carcinomas, annual incidence was declining only for middle/high income patients and females, which supporting prior investigations that low income patients and males are experiencing barriers to definitive treatment for pituitary adenomas. Incidence was also found to be greatest Blacks and urban residents.
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Affiliation(s)
- Arash Ghaffari-Rafi
- University of Hawai'i at Mānoa, John A. Burns School of Medicine (Honolulu), Hawaii, USA; University of California, Davis, School of Medicine, Department of Neurological Surgery (Sacramento), CA, USA.
| | - Rana Mehdizadeh
- University of Queensland, Faculty of Medicine (Brisbane), Australia
| | | | - Jose Antonio Castillo
- University of California, Davis, School of Medicine, Department of Neurological Surgery (Sacramento), CA, USA
| | | | - Jose Leon-Rojas
- University College London, Queen Square Institute of Neurology, London, England, UK; Universidad Internacional del Ecuador Escuela de Medicina, Quito, Ecuador
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11
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Farnworth MT, Yuen KCJ, Chapple KM, Matthees NG, White WL, Little AS, Rogers L, Hughes JN. Evolution of postoperative pituitary adenoma resection cavities assessed by magnetic resonance imaging and implications regarding radiotherapy timing and modality. Clin Imaging 2021; 82:110-116. [PMID: 34801841 DOI: 10.1016/j.clinimag.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This study evaluates the temporal evolution of the spatial relationship between the pituitary adenoma transsphenoidal surgical cavity and the adjacent optic chiasm and discusses implications on timing and choice of radiotherapy modality. METHODS This retrospective observational review analyzed factors that might influence the postoperative relationship between the surgical cavity and the optic chiasm, including tumor type, craniocaudal tumor and resection cavity dimensions, the preoperative distance between tumor and the optic chiasm, the presence of cavernous sinus invasion, and the choice of intraoperative packing material. Changes observed on magnetic resonance imaging in the preoperative, immediate (within 72 h), and delayed (≥3 months) postoperative periods were compared. RESULTS Sixty-five patient histories were analyzed. Preoperatively, the pituitary adenoma was apposed to the optic chiasm in 43 patients (66%). Postoperatively, 34 patients (52%) in the immediate postoperative period and 54 patients (83%) in the delayed postoperative period had a distance ≥2 mm between the resection cavity and the optic chiasm. This distance provides a greater margin of safety with adjuvant radiosurgery. Preoperative tumor size showed a strong association with postoperative descent of the optic chiasm. CONCLUSIONS Preoperative tumor size and degree of mass effect on the optic chiasm predict postoperative changes. In this study, the distance between the resection cavity and the optic chiasm was greater at ≥3 months postoperatively than in the immediate postoperative period, regardless of preoperative mass effect, indicating radiotherapy planning should be deferred to ≥3 months postoperatively when not precluded by aggressive histological characteristics that necessitate more immediate treatment. PRECIS To investigate the temporal relationship between the postoperative sellar surgical cavity and the adjacent optic apparatus after transsphenoidal resection of pituitary adenomas and the implications for radiotherapy.
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Affiliation(s)
- Michael T Farnworth
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Kevin C J Yuen
- Department of Neuroendocrinology, Barrow Pituitary Center and the Barrow Neuroendocrinology Clinic, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Kristina M Chapple
- Department of Trauma/Acute and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Nicholas G Matthees
- Department of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - William L White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Leland Rogers
- Radiation Oncology, Gamma West Cancer Services, Salt Lake City, UT, United States of America
| | - Jeremy N Hughes
- Department of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America.
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12
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Ghiam MK, Chyou DE, Dable CL, Katz AP, Eichberg DG, Zhang H, Ayala AR, Kargi AY, Komotar RJ, Sargi Z. 30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients. Skull Base Surg 2021; 83:e410-e418. [DOI: 10.1055/s-0041-1729980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Objective The study aimed to (1) quantify readmission rates and common causes of readmission following endoscopic transsphenoidal pituitary surgery (ETPS); (2) identify risk factors that may predict readmission within 30 days; (3) assess postoperative care coordination with endocrinology follow-up; and (4) identify patients for whom targeted interventions may reduce 30-day readmissions.
Methods Retrospective quality improvement review of patients with pituitary adenoma who underwent ETPS from December 2010 to 2018 at a single tertiary care center.
Results A total of 409 patients were included in the study, of which 57 (13.9%) were readmitted within 30 days. Hyponatremia was the most common cause of readmission (4.2%) followed by pain/headache (3.9%), cerebrospinal fluid leak (3.4%), epistaxis (2.7%), hypernatremia (1.2%), and adrenal insufficiency (1.2%). Patients with hyponatremia were readmitted significantly earlier than other causes (4.3 ± 2.2 vs. 10.6 ± 10.9 days from discharge, p = 0.032). Readmitted patients had significantly less frequent outpatient follow-up with an endocrinologist than the nonreadmitted cohort (56.1 vs. 70.5%, p = 0.031). Patients who had outpatient follow-up with an endocrinologist were at lower risk of readmission compared with those without (odds ratio: 0.46; 95% confidence interval: 0.24–0.88).
Conclusion Delayed hyponatremia is one of the most common causes of 30-day readmission following ETPS. Postoperative follow-up with an endocrinologist may reduce risk of 30-day readmission following ETPS.
Implications for Clinical Practice A multidisciplinary team incorporating otolaryngologist, neurosurgeons, and endocrinologist may identify patients at risk of 30-day readmissions. Protocols checking serum sodium within 1 week of surgery in conjunction with endocrinologist to tailor fluid restriction may reduce readmissions from delayed hyponatremia.
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Affiliation(s)
- Michael K. Ghiam
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Darius E. Chyou
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Cortney L. Dable
- University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Andrew P. Katz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Daniel G. Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Hang Zhang
- Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, Florida, United States
| | - Alejandro R. Ayala
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Atil Y. Kargi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ricardo J. Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Zoukaa Sargi
- Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, United States
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13
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Hunsaker J, Khan M, Makarenko S, Evans J, Couldwell W, Karsy M. Prediction of Readmission and Complications After Pituitary Adenoma Resection via the National Surgical Quality Improvement Program (NSQIP) Database. Cureus 2021; 13:e14809. [PMID: 34123604 PMCID: PMC8191857 DOI: 10.7759/cureus.14809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Pituitary adenomas are common intracranial tumors (incidence 4:100,000 people) with good surgical outcomes; however, a subset of patients show higher rates of perioperative morbidity. Our goal was to identify risk factors for postoperative complications or readmission after pituitary adenoma resection. Methods We undertook a retrospective cohort study of patients who underwent surgery for pituitary adenoma in 2006-2018 by using the National Surgical Quality Improvement Program database. The main outcome measures were patient complications and the 30-day readmission rate. Results Among the 2,292 patients (mean age 53.3±15.9 years), there were 491 complications in 188 patients (8.2%). Complications and 30-day readmission have remained stable over time rather than declined. Unplanned readmission was seen in 141 patients (6.2%). Multivariable analysis demonstrated that hypertension (OR=1.6; 95% CI= 1.1, 2.1; p=0.005) and high white blood cell count (OR=1.08; 95% CI=1.03, 1.1; p=0.0001) were independent predictors of complications. Return to the operating room (OR=5.9, 95% CI=1.7, 20.2, p=0.0005); complications (OR=4.1, 95% CI=1.6, 10.6, p=0.004); and blood urea nitrogen (OR=1.08, 95% CI=1.02, 1.2, p=0.02) were independent predictors of 30-day readmission. Conclusion Using one of the largest datasets of pituitary adenoma patients, we identified perioperative factors most critical for patient outcome. One strength of this study is adjusting for cofactors that predict outcomes, which has not been done previously. Several patient biomarkers, namely white blood cell count and blood urea nitrogen, may serve as preoperative markers that might identify patients at higher risk. Control of blood pressure and renal disease may be perioperative management strategies that can impact the outcome.
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Affiliation(s)
- Joshua Hunsaker
- Neurological Surgery, University of Utah, Salt Lake City, USA
| | - Majid Khan
- Medicine, Reno School of Medicine, University of Nevada, Reno, USA
| | - Serge Makarenko
- Neurological Surgery, University of Utah, Salt Lake City, USA
| | - James Evans
- Neurosurgery, Thomas Jefferson Medical College, Philadelphia, USA
| | | | - Michael Karsy
- Neurological Surgery, University of Utah, Salt Lake City, USA
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14
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Clival prolactinoma masquerading as a chordoma: a case report. Radiol Case Rep 2021; 16:1320-1324. [PMID: 33897924 PMCID: PMC8053778 DOI: 10.1016/j.radcr.2021.02.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/23/2022] Open
Abstract
Ectopic pituitary adenomas are a rare clinical entity and are frequently mistaken for other base of skull lesions on imaging. We report the clinical presentation and management of a woman presenting with an ectopic prolactinoma located in the clivus. A 66-year-old female presented with a 6-month history of headaches and light-headedness. Anatomical imaging demonstrated a clival lesion most suspicious for chordoma. Endocrinological assessment revealed modestly increased prolactin level with lower-than-expected gonadotrophins levels for her age. Surgical resection confirmed an ectopic prolactinoma. A skull base lesion in a patient with hormonal derangement should lend to a high clinical suspicion of an EPA as they may be treated with medications before surgery. Guidelines could assist clinicians investigating skull-based lesions to identify the rare, but important diagnosis of ectopic pituitary adenomas.
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15
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Garg A, Mishra SK, Dubey S, Singh VP, Kuchay MS, Mithal A. Low-dose ACTH test for evaluation of hypothalamus-pituitary-adrenal axis preoperatively and 3-month follow-up in non-functioning pituitary adenomas. J Endocrinol Invest 2020; 43:1769-1777. [PMID: 32436184 DOI: 10.1007/s40618-020-01292-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peri-operative glucocorticoids are routinely administered to patients undergoing trans-sphenoidal surgery for non-functional pituitary adenomas (NFPA) irrespective of hypothalamus-pituitary-adrenal (HPA) axis status. PURPOSE Evaluation of HPA axis before and 12 weeks after endoscopic trans-sphenoidal adenomectomy (E-TSA) utilizing low-dose (1 μg) ACTH stimulation test (LDACTH) to determine the need for glucocorticoid administration in patients with NFPA. We also determined the factors that can predict occurrence of hypocortisolism at 12 weeks after surgery. METHODS Sixty-three consecutive patients with NFPA requiring surgical excision were enrolled in this study. Glucocorticoids were administered to patients with demonstrable hypocortisolism [preoperative peak cortisol < 16 μg/dL during LDACTH test, postoperative day 3 (POD-3) 0800 hrs Cortisol < 8 μg/dL or stimulated cortisol (LDACTH) < 16 μg/dL at 12 weeks]. RESULTS Hypocortisolism was present in 43 patients (68.2%) pre-operatively and persisted in 33 patients (52.4%) on POD-3. Thirty-three patients (52.4%) had hypocortisolism at 12 weeks after surgery. Eleven patients (17.4%) did not require glucocorticoids during the entire study period and 30 patients (47.6%) did not require glucocorticoids after 3 months. None of the patients developed adrenal crisis during the study. Hypocortisolism on the third post-operative day was the single significant predictor of hypocortisolism at 12 weeks after the surgery. There was a significant correlation between POD-3 0800 hrs cortisol ≥ 8μg/dL and stimulated cortisol (LDACTH) ≥16μg/dL at 12 weeks (r = 0.62, p < 0.0001). POD-3 0800 hrs cortisol ≥ 8 μg/dL had 73% sensitivity and 79% specificity in predicting eucortisolism at 12 weeks. CONCLUSIONS HPA function is preserved in significant proportion of NFPA patients undergoing E-TSA. Perioperative glucocorticoids should be given only in patients with demonstrable preoperative hypocortisolism on 1 μg ACTH test. Postoperative day 3 0800 hrs cortisol is a reasonable predictor of HPA axis status at 12 weeks after surgery.
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Affiliation(s)
- A Garg
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India
| | - S K Mishra
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India.
| | - S Dubey
- Division of Neurosciences, Medanta-The Medicity, Gurugram, Haryana, India
| | - V P Singh
- Division of Neurosciences, Medanta-The Medicity, Gurugram, Haryana, India
| | - M S Kuchay
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India
| | - A Mithal
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India
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16
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Chung WH, Chiu CK, Wei Chan CY, Kwan MK. Rapid progression of scoliosis curve in a mature patient with undiagnosed pituitary macroadenoma: A rare case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:561-564. [PMID: 33155569 DOI: 10.5152/j.aott.2020.19144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Growth hormone secreting pituitary tumor or gigantism has not been previously reported to be associated with rapid progression of scoliosis in the literature. However, there are some reports indicating scoliosis can be worsened by growth hormone therapy in children and adolescents. A 19-year-old boy was referred to our institution for the treatment of a right thoracolumbar scoliosis. The Cobb angle had worsened from 29° to 83° over two years' duration. He attained puberty at the age of 13. He had a previous history of slipped upper femoral epiphysis (SUFE), which was operated in 2015, with no clinical features of gigantism. Preoperative assessment was performed. He was diagnosed with growth hormone secreting pituitary macroadenoma by magnetic resonance imaging with a high serum level of insulin-like growth factor-I (IGF-I). Computed tomography (CT) of the pancreas showed a pancreatic endocrine tumor. The patient was later diagnosed with multiple endocrine neoplasia type 1 (MEN 1). He underwent endoscopic endonasal excision of the pituitary mass and distal pancreatectomy. This case indicates that growth hormone secreting pituitary macroadenoma could result in rapid progression of scoliosis.
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Affiliation(s)
- Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), University of Malaya, School of Medicine, Kuala Lumpur, Malaysia
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17
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Jaafar AS, Mohd Shokri SS, Paramasvaran S, Palaniandy K, Fadzil F. Now You See, Now You Don't: A Case Of Spontaneous Regression of Pituitary Tumour. Cureus 2020; 12:e9174. [PMID: 32802610 PMCID: PMC7425821 DOI: 10.7759/cureus.9174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Spontaneous regression of pituitary tumours are rare and can be due to tumour ischaemia, pituitary apoplexy, or lymphocytic hypophysitis. We report a case of a 32-year-old female, who presented with symptoms and signs of extrasellar pituitary enlargement and hypothyroidism. MRI revealed a pituitary mass that spontaneously regressed after a month, with complete resolution of symptoms. Not all pituitary tumours require surgical intervention especially in the case of autoimmune lymphocytic hypophysitis.
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Affiliation(s)
| | | | | | - Kamalanathan Palaniandy
- Neurosurgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, MYS.,Neurosurgery, Universiti Sains Malaysia, Kuala Lumpur, MYS
| | - Farizal Fadzil
- Neurosurgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, MYS
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18
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Ambulatory Surgery Protocol for Endoscopic Endonasal Resection of Pituitary Adenomas: A Prospective Single-arm Trial with Initial Implementation Experience. Sci Rep 2020; 10:9755. [PMID: 32546762 PMCID: PMC7297807 DOI: 10.1038/s41598-020-66826-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
Endoscopic endonasal transsphenoidal resection has been accepted as a routine therapy for pituitary adenoma, but the postoperative hospital stay is typically several days long. With the advantages of reduced cost and improved patient satisfaction, the application of ambulatory surgery (AS) has developed rapidly. However, AS was still rarely adopted in neurosurgery. Here we designed an AS treatment protocol for pituitary adenoma with the endoscopic endonasal approach (EEA), and reported our initial experiences regarding the safety and efficacy of the AS protocol. 63 patients who presented with pituitary adenoma were screened at the Department of Neurosurgery, Tangdu Hospital from July to September, 2017. A total of 20 pituitary adenoma patients who met the inclusion criteria underwent EEA surgery using this evidence-based AS protocol, which emphasized adequate assessment for eligibility, full preparation to minimize invasiveness, enhanced recovery, and active perioperative patient education. Of the 20 patients enrolled, 18 were discharged on the afternoon of the operation day with a median total length of stay (LOS) of 31 hours (range, 29–32) hours. The median LOS after surgery was 6.5 (range, 5–8) hours. Two patients were transferred from the AS protocol to conventional care due to intraoperative cerebrospinal fluid leakage (one case) and an unsatisfying post-anesthetic discharge score (one case). Complications included transient and reversible mild postoperative nausea and vomiting [visual analog scale (VAS) score <3], headache (VAS score <3) after the operation or early after discharge. No patient was readmitted. Our results supported the safety and efficacy of the AS protocol for pituitary adenoma patients undergoing EEA resection among eligible patients, and further evaluation of this protocol in controlled studies with a larger sample size is warranted.
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Soon WC, Czyz M, Dhir J. Metastatic Pituitary Carcinoma Causing Cord Compression. World Neurosurg 2020; 139:266-267. [PMID: 32289505 DOI: 10.1016/j.wneu.2020.03.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/28/2022]
Abstract
A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. During follow-up, he was noted to have rising basal adrenocorticotrophin (ACTH) level. On examination, he was neurologically intact with no signs of myelopathy. Magnetic resonance imaging of the spine showed a large intradural extramedullary lesion causing cord compression at the C2-3 level. He underwent a cervical laminectomy and debulking of the lesion under continuous monitoring of motor-evoked and somatosensory-evoked potentials. He remained neurologically intact postoperatively. Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.
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Affiliation(s)
- Wai Cheong Soon
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
| | - Marcin Czyz
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jasmeet Dhir
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Caulley L, Quinn JG, Doyle MA, Alkherayf F, Kilty S, Hunink MGM. Surgical and non-surgical interventions for primary and salvage treatment of growth hormone-secreting pituitary adenomas in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lisa Caulley
- University of Ottawa, Ottawa Hospital Research Institute; Department of Otolaryngology - Head and Neck Surgery; 500 Smyth Road Ottawa Ontario Canada N4K7A2
| | - Jason G Quinn
- Dalhousie University; Department of Pathology and Laboratory Medicine; 5788 University Avenue Halifax Nova Scotia Canada B3H 1V8
| | - Mary-Anne Doyle
- University of Ottawa; Endocrinology and Metabolism; Ottawa Ontario Canada
| | - Fahad Alkherayf
- The Ottawa Hospital; Neurosurgery; 1053 Carling Avenue, Room C2118 Ottawa Ontario Canada K1Y 4E9
| | - Shaun Kilty
- University of Ottawa; Department of Otolaryngology - Head and Neck Surgery; 132-737 Parkdale Avenue Ottawa ON Canada K1Y 1J8
| | - M G Myriam Hunink
- Erasmus MC; Department of Epidemiology; PO Box 2040 Rotterdam Netherlands 3000 CA
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21
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Grayson JW, Nayak A, Winder M, Jonker B, Alvarado R, Barham H, McCormack A, Harvey RJ. Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma. J Neurol Surg B Skull Base 2019; 82:295-302. [PMID: 34026405 DOI: 10.1055/s-0039-1700498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/13/2019] [Indexed: 12/24/2022] Open
Abstract
Objective Despite multidisciplinary care being commonly recommended, there remains limited evidence supporting its benefits in pituitary disease management. This study aimed to assess the impact of multidisciplinary care in pituitary surgery. Methods A retrospective cohort study was performed comparing pituitary surgery outcomes among consecutive patients within a quaternary referral center in 5 years before and after introduction of a multidisciplinary team (MDT). Primary outcomes were endocrine (transient diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH], and new hypopituitarism) and surgical (cerebrospinal fluid [CSF] leak, epistaxis, intracranial hemorrhage, and meningitis) complications, length of hospital stay, and intrasellar residual tumor. Results 279 patients (89 pre-MDT vs. 190 post-MDT) were assessed (age 54 ± 17 years, 48% female). Nonfunctioning adenomas were most common (54%). In the post-MDT era, more clinically functioning tumors (42 vs. 28%, p = 0.03) were treated. Transient DI and SIADH occurred less often post-MDT (20 vs. 36%, p < 0.01 and 18 vs. 39%, p < 0.01), as well as new hypothyroidism (5 vs. 15, p < 0.01). Hospital stay was shorter post-MDT (5[3] vs. 7[5] days, p < 0.001) and intrasellar residuals were less common (8 vs. 35%, p < 0.001). Complications were more frequent pre-MDT independent of tumor size, hormone status, and surgical technique (odds ratio [OR] = 2.14 [1.05-4.32], p = 0.04). Conclusion Outcomes of pituitary surgery improved after the introduction of an MDT. Pituitary MDTs may benefit both patients and the health system by improving quality of care and reducing hospital stays.
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Affiliation(s)
- Jessica W Grayson
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Agnish Nayak
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Mark Winder
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia
| | - Benjamin Jonker
- Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia.,Department of Neurosurgery, Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - Henry Barham
- Sinus and Nasal Specialists of Louisiana, Louisiana, United States
| | - Ann McCormack
- Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Abstract
Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging. Providing patient counseling and close postoperative follow-up is important to effectively manage diabetes insipidus and reduce hospital readmissions due to sodium perturbations.
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Affiliation(s)
- Kevin C J Yuen
- Department of Neuroendocrinology, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, 124 W Thomas Road, Suite 300, Phoenix, AZ 85013, USA.
| | - Adnan Ajmal
- Department of Internal Medicine and Endocrinology, St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, 500 W Thomas Road, Suite 900B Phoenix, AZ 85013, USA
| | - Ricardo Correa
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Phoenix Veterans Administration Medical Center, University of Arizona College of Medicine, Creighton School of Medicine and Mayo School of Medicine, 650 E Indian School Road, Building 21, Suite 117, Phoenix, AZ 85014, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Pituitary Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine, 300 W Thomas Road, Phoenix, AZ 85013, USA
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Morinaga Y, Nii K, Sakamoto K, Inoue R, Mitsutake T, Hanada H. Case of Acromegaly Caused by Rathke Cleft Cyst Mimicking Plurihormonal Pituitary Adenoma. World Neurosurg 2019; 126:570-575. [PMID: 30862574 DOI: 10.1016/j.wneu.2019.02.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Acromegaly caused by Rathke cleft cyst (RCC) mimicking a plurihormonal pituitary adenoma (PA) is rare. CASE DESCRIPTION We report a 71-year-old woman who presented with hyperhidrosis in 2013. Magnetic resonance imaging performed in April 2018 revealed that the patient had a pituitary tumor, and she was referred to our hospital. She presented with an acromegaly-like appearance with mild hypertrophy at her limb extremities. Preoperative blood tests, magnetic resonance imaging, and an endocrine tolerance test indicated that the patient's symptoms satisfied the diagnostic criteria for acromegaly, with a suspected diagnosis of an RCC and growth hormone (GH)-producing PA. Endoscopic transsphenoidal surgery (eTSS) was performed. Permanent pathologic diagnosis showed an RCC mimicking a plurihormonal PA, which was confirmed via immunohistochemistry. Blood sampling 2 months post surgery showed reduced GH (0.41 ng/mL) and increased insulin-like growth factor-1 (IGF-1) (356 ng/mL) levels. In addition, a postoperative endocrine tolerance test revealed a parasitic reaction of GH and secondary adrenocortical hypofunction. No RCC recurrence was found, and the GH (0.32 ng/mL) and previously increased IGF-1 (169 ng/mL) levels were normalized 12 months after eTSS. CONCLUSIONS We reported a rare case of acromegaly caused by RCC mimicking a plurihormonal PA. This case suggests that inflammation associated with RCC might be involved in the development of adenomatous cells. Postoperative clinical symptoms and elevated fibrinogen and IGF-1 levels later improved. This outcome suggested that the transient increase in IGF-1 2 months after surgery might reflect RCC-induced inflammation.
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Affiliation(s)
- Yusuke Morinaga
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan.
| | - Kouhei Nii
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan
| | - Kimiya Sakamoto
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan
| | - Ritsurou Inoue
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan
| | - Takafumi Mitsutake
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan
| | - Hayatsura Hanada
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino-city, Japan
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Solari D, Zenga F, Angileri FF, Barbanera A, Berlucchi S, Bernucci C, Carapella C, Catapano D, Catapano G, Cavallo LM, D'Arrigo C, de Angelis M, Denaro L, Desogus N, Ferroli P, Fontanella MM, Galzio RJ, Gianfreda CD, Iacoangeli M, Lauretti L, Locatelli D, Locatelli M, Luglietto D, Mazzatenta D, Menniti A, Milani D, Nasi MT, Romano A, Ruggeri AG, Saladino A, Santonocito O, Schwarz A, Skrap M, Stefini R, Volpin L, Wembagher GC, Zoia C, Zona G, Cappabianca P. A Survey on Pituitary Surgery in Italy. World Neurosurg 2019; 123:e440-e449. [DOI: 10.1016/j.wneu.2018.11.186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
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25
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Deb S, Vyas DB, Pendharkar AV, Rezaii PG, Schoen MK, Desai K, Gephart MH, Desai A. Socioeconomic Predictors of Pituitary Surgery. Cureus 2019; 11:e3957. [PMID: 30956910 PMCID: PMC6436671 DOI: 10.7759/cureus.3957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: There exists a lack of data on the effect of socioeconomic status (SES) on outcomes for pituitary tumors, which have been associated with significant morbidity. The goal of this population-level study is to investigate the role of SES on receiving treatment and survival in patients with pituitary tumors. Methods: The Surveillance, Epidemiology, and End Results (SEER) program database from the National Cancer Institute was used to identify patients diagnosed with pituitary tumors between 2003 and 2012. SES was determined using a validated composite index. Race was categorized as Caucasian and non-Caucasian. Treatment received included surgery, radiation, and radiation with surgery. Odds of receiving surgery and survival probability were analyzed using multivariate logistic regression and Cox proportional hazards model, respectively. Results: A total of 25,802 patients with pituitary tumors were identified for analysis. High SES tertile (odds ratio (OR) = 1.095; 95% confidence interval (CI) [1.059, 1.132]) and quintile (OR = 1.052; 95% CI [1.031, 1.072]) were associated with higher odds of receiving surgery (p<0.0001). Caucasian patients had higher odds of receiving surgery when compared to non-Caucasian patients (OR = 1.064; 95% CI [1.000, 1.133]; p<0.05). Neither SES nor race were significant predictors of survival probability. Conclusion: Socioeconomic status and race were found to be associated with higher odds of receiving surgery for pituitary tumors, and thus serve as independent predictors of surgical management. Further studies are required to investigate possible causes for these findings.
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Affiliation(s)
- Sayantan Deb
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Daivik B Vyas
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | | | - Paymon G Rezaii
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Matthew K Schoen
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Kaniksha Desai
- Internal Medicine, Stanford University School of Medicine, Stanford, USA
| | | | - Atman Desai
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
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26
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Hamill CS, Villwock JA, Sykes KJ, Chamoun RB, Beahm DD. Socioeconomic Factors Affecting Discharge Status of Patients with Uncomplicated Transsphenoidal Adenohypophysectomy. J Neurol Surg B Skull Base 2018; 79:501-507. [PMID: 30210979 DOI: 10.1055/s-0038-1635095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/19/2018] [Indexed: 10/17/2022] Open
Abstract
Objectives The number of transsphenoidal adenohypophysectomies (TSAs) surgeries has grown significantly since 1993. While there has been an overall decreasing trend in length of stay (LOS), socioeconomic factors may impact hospitalization. This study explores the impact of socioeconomic factors on LOS and total charges in uncomplicated patients undergoing TSA. Design Retrospective cohort. Setting 2009 to 2013 Nationwide Inpatient Sample. Participants Patients undergoing TSA without medical complications. Main Outcomes Measures LOS and total charges. Results A total of 6,457 patients were identified, of which 17.2% had secreting tumors. Patients with secreting tumors stayed 2.95 days versus those with nonsecreting tumors stayed 3.26 days ( p < 0.001). Discharge to other than self-care was the largest contributing variable for both subsets, increasing both LOS and total charges. Patient factors that drove longer LOS and increased total charges for both subsets included metropolitan domicile, having a lower median income, Hispanic ethnicity, and having an increased amount of Agency for Healthcare Research and Quality (AHRQ) comorbidity indices. Having private insurance predicted a shorter LOS and lower total charges. Conclusions These results demonstrate that, even without complications, patients can be delayed in their discharge. While several socioeconomic factors significantly predict LOS and charges, the discharge disposition ultimately has the greatest effect. This suggests that efforts should focus on improving organizational factors such as coordination with social work and outside facilities to decrease LOS and charges for this patient population.
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Affiliation(s)
- Chelsea S Hamill
- Department of Otolaryngology-Head and Neck Surgery, CWRU/University Hospitals, Cleveland Medical Center, Cleveland, Ohio, United States
| | - Jennifer A Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Roukoz B Chamoun
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - D David Beahm
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States
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27
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Subbarayan RS, Koester L, Villwock MR, Villwock J. Proliferation and Contributions of National Database Studies in Otolaryngology Literature Published in the United States: 2005-2016. Ann Otol Rhinol Laryngol 2018; 127:643-648. [PMID: 30047790 DOI: 10.1177/0003489418784968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Health registries and discharge-level databases are powerful tools. Commonly used data sets include the Nationwide Inpatient Sample (NIS); Surveillance, Epidemiology, and End Results Program (SEER); National Cancer Database (NCDB); and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This study investigated the frequency with which these resources are being used and categorized their contributions to literature. DESIGN A literature review from 2005 to 2016 for papers utilizing the aforementioned databases and publishing in The Laryngoscope, JAMA-Otolaryngology, Head and Neck, Otolaryngology-Head and Neck Surgery, and International Forum of Allergy and Rhinology was conducted. Results were categorized based on the contribution(s) of the paper. The incidence rate of database publications was calculated for each year along with the 95% confidence intervals using a Poisson distribution. RESULTS Three hundred ten studies were identified. Seventy percent report descriptive findings, and 65% report outcomes/survival. Approximately 18% made clinical recommendations. In 2005, the incidence rate of database publications was 3 per 1000 journal publications (95% CI, 1-9) and remained relatively stable until 2008. From 2010 onward, there was a persistent increase in publications, culminating in the highest incidence rate in 2016 of 26 database publications per 1000 journal publications (95% CI, 20-32). CONCLUSIONS There was a nearly 10-fold increase in database publications in 2016 compared to 2005. The majority provide descriptive data and outcomes measures. The role of these studies warrants further investigation.
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Affiliation(s)
| | - Lindsey Koester
- 2 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark R Villwock
- 1 Kansas University Medical Center, Kansas City, Kansas, USA
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McKee S, Yang A, Kidwai S, Govindaraj S, Shrivastava R, Iloreta A. The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015. Int Forum Allergy Rhinol 2018; 8:1145-1156. [PMID: 30007017 DOI: 10.1002/alr.22148] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prolonged length of stay (pLOS), disease-related complications, and 30-day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient-level and hospital-level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery. METHODS The Statewide Planning and Research Cooperative System (SPARCS) database was queried to investigate 30-day readmissions and pLOS for transsphenoidal pituitary surgery in New York from 1995 to 2015. Multivariate logistic regression, adjusting for patient and hospital characteristics, was performed to assess the effect of these variables on the outcomes of interest. RESULTS A total of 9950 patients underwent transsphenoidal pituitary surgery; 7122 (72%), 2394 (24%), and 434 (4%) patients were treated at high-volume, medium-volume, and low-volume centers, respectively. Patient factors associated with treatment at high-volume centers (HVCs) included: top income quartile, private insurance, urban residence, and white or Asian race (p < 0.05). Patient variables associated with treatment at low-volume centers (LVCs) included: age >65 years, elevated Charlson comorbidity index (CCI) scores, bottom income quartile, Medicaid and Medicare insurance, rural residence, black race, and Hispanic ethnicity (p < 0.05). Variables predictive of prolonged hospitalizations in our multivariable model included black race, Hispanic ethnicity, Medicaid insurance, low income, female gender, LVC, and comorbidities (panhypopituitarism, hypothyroidism, diabetes insipidus [DI], visual disturbances, CCI) while predictors of readmissions included Asian race, female gender, and comorbidities (Cushing syndrome, DI, CCI). CONCLUSION Patients undergoing transsphenoidal pituitary surgery at HVCs have shorter hospitalizations, fewer postoperative electrolyte abnormalities, and lower charges; however, socioeconomic factors may influence access to quality care.
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Affiliation(s)
- Sean McKee
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anthony Yang
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah Kidwai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alfred Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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29
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Crowther S, Rushworth RL, Rankin W, Falhammar H, Phillips LK, Torpy DJ. Trends in surgery, hospital admissions and imaging for pituitary adenomas in Australia. Endocrine 2018; 59:373-382. [PMID: 29103185 DOI: 10.1007/s12020-017-1457-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE There is a paucity of epidemiological information on treatment and imaging of pituitary adenomas in Australia. METHODS Australian data on pituitary surgery, hospital admissions for pituitary adenomas, and pituitary imaging on patients 15 years and over were obtained from administrative databases between 2000/2001 and 2014/2015. Changes over time and by age and sex were assessed. RESULTS In 2014/15 there were 37.7 pituitary procedures/million population, corresponding to a 35.4% (p < 0.05) increase over the 2000/2001 rate. Overall, most (87.2%) procedures were partial excisions of pituitary gland via transsphenoidal surgery (TSS). Admissions for acromegaly increased from 7.1/million in 2000/2001 to 17.2/million in 2003/2004 and then decreased to 6.5/million in 2014/2015. The average age-adjusted rate of pituitary imaging over the study period was 689.6/million/year, which increased significantly (p < 0.05). There was a significant increase in pituitary MRIs (p < 0.05) and a significant decline in pituitary CTs (p < 0.05). Surgical procedure rates were correlated with the pituitary imaging rates (r = 0.62, p < 0.05). CONCLUSION Pituitary surgery rates increased between 2000/2001 and 2014/2015. The most common procedure was partial excision of the pituitary gland via TSS. Admissions for pituitary neoplasms increased over the study while admissions for acromegaly rose to their highest rate in 2003/2004 and then decreased. There was a substantial increase in the rate of pituitary imaging, which may have resulted in increased detection of pituitary incidentalomas. The underlying reasons for the increased rate of pituitary surgery, and the non-sustained increased rate of admissions for acromegaly are unclear and warrant further investigation.
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Affiliation(s)
- Sjorjina Crowther
- School of Medicine, The University of Notre Dame Australia, 60 Oxford St, Darlinghurst, NSW, Australia.
| | - R Louise Rushworth
- School of Medicine, The University of Notre Dame Australia, 60 Oxford St, Darlinghurst, NSW, Australia
| | - Wayne Rankin
- Division of Chemical Pathology, SA Pathology, Frome Road, Adelaide, SA, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research, Royal Darwin Hospital, Darwin, Australia
| | - Liza K Phillips
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Frome Road, Adelaide, SA, Australia
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Frome Road, Adelaide, SA, Australia
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Walker MJ, Rogers WA. Diagnosis, narrative identity, and asymptomatic disease. THEORETICAL MEDICINE AND BIOETHICS 2017; 38:307-321. [PMID: 28681328 DOI: 10.1007/s11017-017-9412-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve 'mismatches' between one's beliefs about one's health status on the one hand, and bodily sensations or past experience on the other. Patients' attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety.
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Affiliation(s)
- Mary Jean Walker
- Philosophy Department, Building 11, Monash University, Melbourne, VIC, 3800, Australia.
| | - Wendy A Rogers
- Department of Philosophy, Macquarie University, Sydney, NSW, 2109, Australia
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, 2109, Australia
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Wang W, Fu L, Li S, Xu Z, Qiu P, Xu TJ, Yang W, Zhang YB, Xu GM, Lu XD, Li X. Vitamin D insufficiency correlates with peripheral B10 cells in patients with pituitary tumours. Cell Biochem Funct 2017; 35:254-259. [PMID: 28749078 DOI: 10.1002/cbf.3270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/06/2017] [Accepted: 05/20/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Weimin Wang
- School of Medicine; Shandong University; Jinan China
- Departments of Neurosurgery and Surgery Room, Qingdao Municipal Hospital; Qingdao China
| | - Li Fu
- Departments of Neurosurgery and Surgery Room, Qingdao Municipal Hospital; Qingdao China
| | - Shengli Li
- Departments of Neurosurgery and Surgery Room, Qingdao Municipal Hospital; Qingdao China
| | - Zhiming Xu
- Departments of Neurosurgery and Surgery Room, Qingdao Municipal Hospital; Qingdao China
| | - Peng Qiu
- Department of Neurosurgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
| | - Tong-Jiang Xu
- Department of Neurosurgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
| | - Wei Yang
- Department of Neurosurgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
| | - Yu-Bao Zhang
- Department of Neurosurgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
| | - Guang-Ming Xu
- Department of Neurosurgery; Shandong Provincial Hospital affiliated to Shandong University; Jinan China
| | - Xiang-Dong Lu
- Department of Neurosurgery; Laiwu City People's Hospital; Laiwu China
| | - Xinggang Li
- Department of Neurosurgery; Qilu Hospital of Shandong University; Jinan China
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Cote DJ, Dasenbrock HH, Muskens IS, Broekman MLD, Zaidi HA, Dunn IF, Smith TR, Laws ER. Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors. J Am Coll Surg 2017; 224:971-979. [PMID: 28279778 DOI: 10.1016/j.jamcollsurg.2017.02.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. STUDY DESIGN Patients undergoing transsphenoidal surgery from 2006 to 2015 were extracted from the American College of Surgeons NSQIP database. Logistic regression was used to identify predictors of 30-day complications. RESULTS Of 1,240 patients included in this analysis, 6.9% experienced a major complication, and 9.4% experienced any complication within 30 days. Other adverse events included death in 0.7% and nonroutine hospital discharge in 5.3%. Most adverse events occurred within the first 2 weeks postoperatively; 82.9% of patients experienced their first complication during the initial hospital stay. Multivariable analysis demonstrated that predictors of hospital stay longer than 4 days included American Society of Anesthesiologists classification III to V (p = 0.015), insulin-dependent diabetes mellitus (p < 0.001), and operative time in the third and fourth quartiles (both p < 0.001). American Society of Anesthesiologists classification III to V and operative time in the fourth quartile were also predictors of any adverse event (p = 0.01 and p = 0.005, respectively). Among these patients, 3.7% underwent reoperation, the most common reason for which was postoperative cerebrospinal fluid leak (63.6%). Readmission occurred after 8.5% of cases at a median of 11.0 days post-discharge. The most common cause of readmission was hyponatremia (29.5%), followed by delayed postoperative cerebrospinal fluid leak (16.0%). CONCLUSIONS Overall rates of adverse events in patients undergoing transsphenoidal surgery are relatively low, and most occur before discharge from the hospital. Post-discharge complications associated with transsphenoidal surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed postoperative cerebrospinal fluid leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.
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Affiliation(s)
- David J Cote
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hormuz H Dasenbrock
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ivo S Muskens
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Marike L D Broekman
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Hasan A Zaidi
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ian F Dunn
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Timothy R Smith
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Edward R Laws
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Bir SC, Patra DP, Maiti TK, Sun H, Guthikonda B, Notarianni C, Nanda A. Epidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients. Neurosurg Focus 2017; 41:E5. [PMID: 27581317 DOI: 10.3171/2016.7.focus16188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adult-onset hydrocephalus is not commonly discussed in the literature, especially regarding its demographic distribution. In contrast to pediatric hydrocephalus, which is related to a primary CSF pathway defect, its development in adults is often secondary to other pathologies. In this study, the authors investigated the epidemiology of adult-onset hydrocephalus as it pertains to different etiologies and in reference to age, sex, and race distributions. METHODS The authors retrospectively reviewed the clinical notes of 2001 patients with adult-onset hydrocephalus who presented to Louisiana State University Health Sciences Center within a 25-year span. Significant differences between the groups were analyzed by a chi-square test; p < 0.05 was considered significant. RESULTS The overall mean (± SEM) incidence of adult hydrocephalus in this population was 77 ± 30 per year, with a significant increase in incidence in the past decade (55 ± 3 [1990-2003] vs 102 ± 6 [2004-2015]; p < 0.0001). Hydrocephalus in a majority of the patients had a vascular etiology (45.5%) or was a result of a tumor (30.2%). The incidence of hydrocephalus in different age groups varied according to various pathologies. The incidence was significantly higher in males with normal-pressure hydrocephalus (p = 0.03) or head injury (p = 0.01) and higher in females with pseudotumor cerebri (p < 0.0001). In addition, the overall incidence of hydrocephalus was significantly higher in Caucasian patients (p = 0.0002) than in those of any other race. CONCLUSIONS Knowledge of the demographic variations in adult-onset hydrocephalus is helpful in achieving better risk stratification and better managing the disease in patients. For general applicability, these results should be validated in a large-scale meta-analysis based on a national population database.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Devi Prasad Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Tanmoy K Maiti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Hai Sun
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Hanba C, Svider PF, Shkoukani MA, Sheyn A, Jacob JT, Eloy JA, Folbe AJ. Pediatric pituitary resection: characterizing surgical approaches and complications. Int Forum Allergy Rhinol 2016; 7:72-79. [PMID: 27626904 DOI: 10.1002/alr.21840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/04/2016] [Accepted: 07/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery. METHODS The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed. RESULTS A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%). CONCLUSION A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children undergoing transsphenoidal surgery.
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Affiliation(s)
- Curtis Hanba
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI
| | - Mahdi A Shkoukani
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI
| | - Anthony Sheyn
- Department of Otolaryngology-Head and Neck Surgery, The University of Tennessee Health Science Center School of Medicine, Memphis, TN.,LeBonheur Children's Hospital, Department of Pediatric Otolaryngology, Memphis, TN
| | - Jeffrey T Jacob
- Michigan Head and Spine Institute, Novi, MI.,William Beaumont Health System, Royal Oak, MI
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ
| | - Adam J Folbe
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI
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Spontaneous pituitary adenoma occurring after resection of a Rathke's cleft cyst. J Clin Neurosci 2016; 33:247-251. [PMID: 27600168 DOI: 10.1016/j.jocn.2016.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/14/2016] [Indexed: 11/21/2022]
Abstract
Rathke's cleft cysts (RCC) are benign cystic lesions that originate from remnants of the epithelial lining of Rathke's pouch. RCC are known rarely to occur together with a concomitant pituitary adenoma. Here, we report a patient with a pituitary adenoma arising in the same location as a previously-resected RCC, 3 years post-operatively, and review the literature of "collision" sellar lesions. Consecutive transsphenoidal operations from a single-center between 2008 and 2016 were reviewed to identify patients with pituitary adenoma arising after surgical resection of RCC, and a systematic search of the literature was also performed to identify such patient reports, as well as reports of concomitant pituitary adenoma and RCC. Of 837 transsphenoidal operations from our own experience, one patient with pituitary adenoma occurring after RCC resection was identified and is reported here. A systematic review of the literature resulted in identification of 34 patients with concomitant RCC and pituitary adenoma and no incidents of pituitary adenoma occurring after resection of RCC. Concomitant occurrence of RCC and pituitary adenoma was more commonly diagnosed in women (61%), at a median age of diagnosis of 44 years. The RCC histological analysis in these patients consistently described ciliated columnar or cuboidal epithelium. Although rare, the presence of a new, pathologically-distinct lesions in the sella after prior surgical treatment, is possible. During post-operative monitoring, physicians should consider that what appears as a "recurrent" lesion may actually be growth of a new and entirely different lesion.
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Lawrence LA, Baker AB, Nguyen SA, Karnezis TT, Soler ZM, Schlosser RJ. Predictors of 30-day morbidity and mortality in transnasal microscopic pituitary tumor excision. Int Forum Allergy Rhinol 2015; 6:206-13. [PMID: 26370600 DOI: 10.1002/alr.21641] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/08/2015] [Accepted: 08/04/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a lack of population-based, multi-institutional analyses of factors associated with morbidity and mortality following pituitary tumor excision. METHODS The American College of Surgeons National Surgical Quality Improvement Project files were used to compile information on patients that had undergone transnasal microscopic pituitary tumor resection from 2006 to 2012. Patient demographics, comorbidities, operative characteristics, and morbidity and mortality in the 30 days following surgery were included. Multivariate logistic regression was used for categorical variables and multivariate linear regression was used for continuous variables to evaluate factors leading to adverse events. RESULTS A total of 658 patients were included, of which 58 (8.81%) experienced a complication, reoperation or death in the 30 days following surgery. The most common complications were reoperation (3.37%), followed by unplanned reintubation (1.99%), urinary tract infection (1.68%), and transfusion (1.68%). Predictors of any complication, reoperation, or death include preoperative sepsis (odds ratio [OR] = 7.596) and lower preoperative serum albumin (OR = 6.667). Younger age predicted surgical complications (OR = 1.105). Predictors of medical complications include higher body mass index (OR = 1.112), chronic steroid use (OR = 6.568), preoperative sepsis (OR = 15.297), and lower preoperative serum hematocrit (OR = 1.225). Predictors of increased total length of hospital stay were older age (β = 0.146), higher body mass index (β = 0.188), chronic steroid use (β = 0.142), preoperative sepsis (β = 0.489), and lower preoperative serum albumin (β = -0.213). CONCLUSION Although adverse events following pituitary tumor excision are low, awareness of factors associated with morbidity and mortality in the early postoperative period may allow for improved patient monitoring and outcomes.
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Affiliation(s)
- Lauren A Lawrence
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Andrew B Baker
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Tom T Karnezis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.,Ralph H. Johnson VA Medical Center, Charleston, SC
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Villwock MR, Padalino DJ, Deshaies EM. Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA. J Neurointerv Surg 2015; 8:457-60. [PMID: 25801774 DOI: 10.1136/neurintsurg-2015-011674] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/03/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) for the treatment of acute ischemic stroke has been growing in popularity while the therapeutic benefit of MT has been increasingly debated. Our objective was to examine national trends in mortality following MT. METHODS We analyzed the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2008-2011) for patients with a primary diagnosis of acute ischemic stroke that received MT. Temporal trends in mortality were examined using Spearman's rank correlation. To account for confounding factors, mortality was further analyzed in binary logistic regression. RESULTS Hospitals performing MT comprised 8% of all hospitals treating ischemic stroke. The percentage of stroke cases treated with MT increased from 0.6% of cases in 2008 to 1.1% in 2012, totaling 16 307 MT cases in a 5 year period. Inhospital mortality decreased over the study period from 25.4% in 2008 to 16.1% in 2012 (r=-0.081, p<0.001). This finding was supported by regression analysis as each incremental year reduced the odds of mortality by 20% (OR=0.832, p<0.001). Administration of recombinant tissue plasminogen activator was associated with a decrease in the odds of mortality (OR=0.805, p<0.001). CONCLUSIONS Utilization of MT represents a small percentage of stroke cases, although the trend is increasing. Mortality following MT has been showing a steady decline over the past 5 years. This may be a result of a learning curve, improved patient selection, and/or device improvements. Randomized trials remain essential to evaluate the potential benefit of endovascular devices and identify the most appropriate patients.
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Affiliation(s)
- Mark R Villwock
- Crouse Neuroscience Institute, Neurovascular and Stroke Center, Syracuse, New York, USA
| | - David J Padalino
- Crouse Neuroscience Institute, Neurovascular and Stroke Center, Syracuse, New York, USA
| | - Eric M Deshaies
- Crouse Neuroscience Institute, Neurovascular and Stroke Center, Syracuse, New York, USA
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Villwock JA, Villwock MR, Goyal P, Deshaies EM. Current trends in surgical approach and outcomes following pituitary tumor resection. Laryngoscope 2015; 125:1307-12. [DOI: 10.1002/lary.25120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 11/12/2014] [Accepted: 12/04/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Jennifer A. Villwock
- Department of Otolaryngology; SUNY Upstate Medical University; Syracuse New York U.S.A
| | - Mark R. Villwock
- Neurovascular and Skull Base Microsurgery Center; Crouse Neuroscience Institute; Syracuse New York U.S.A
| | - Parul Goyal
- Syracuse Otolaryngology; Syracuse New York U.S.A
| | - Eric M. Deshaies
- Neurovascular and Skull Base Microsurgery Center; Crouse Neuroscience Institute; Syracuse New York U.S.A
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39
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Wormald PJ. Editorial: the annual Institute for Scientific Information(ISI). Int Forum Allergy Rhinol 2014; 4:691-2. [PMID: 25182193 DOI: 10.1002/alr.21409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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