Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes

BACKGROUND

Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown.

METHODS

Data from patients who underwent endoscopic TSS for a NFPMA (2009-2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes.

RESULTS

Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm³, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm³, p = 0.004).

CONCLUSION

Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth.

A survey of ethnic foods for microbial quality and aflatoxin content

A range of ethnic foods was examined for their microbiological content in relation to total viable counts (TVC) of aerobic bacteria, counts of presumptive coliforms, yeast and mould counts; presence of Salmonella spp., Listeria monocytogenes, Escherichia coli O157:H7 and Campylobacter spp.; total enumeration of Clostridium perfringens, Staphylococcus aureus and Bacillus spp.; identification of moulds and the presence of total aflatoxins. Samples, which included cereals, nuts, dried fruits, herbs and spices, were obtained from local retail outlets and distributors. It was established that three samples of pistachio nuts contained significant levels of aflatoxins. The concentration of total aflatoxins in these three nut samples ranged from 15 to 259 microg/kg of sample. Only two other samples contained trace amounts of aflatoxins, all other samples analysed were found to be free of any detectable level of aflatoxins. TVCs, coliform counts and yeast and mould counts varied widely depending on the matrix tested. Generally, rice, wheat and peanuts produced low counts whereas other nuts, gram flour and spices produced much higher counts. Cl. perfringens, Staph. aureus, and Bacillus spp. were common in spices, nuts and gram flour, however, Listeria monocytogenes was only detected in four samples and in no sample could Salmonella spp, E. coli O157:H7 or Campylobacter spp. be detected.