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Pituitary Adenomas: Presentations and Outcomes in a South Asian Country

Published online by Cambridge University Press:  02 December 2014

Muhammad Shahzad Shamim ,
Muhammad Ehsan Bari ,
Faraz Khursheed ,
Rashid Jooma  and
Syed Ather Enam
Muhammad Shahzad Shamim
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Muhammad Ehsan Bari
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Faraz Khursheed
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Rashid Jooma
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
Syed Ather Enam
Affiliation:
Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Abstract

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Objective:

: The purpose of this retrospective review of all operated cases of pituitary adenomas in the last decade, is to define the demographic patterns and characteristics of such tumors and to assess surgical outcomes with regards to safety and efficacy of trans–sphenoidal tumor removal in our institution.

Methods:

Surgically treated pituitary adenomas presenting from 1995 till 2005 were reviewed for different variables. Results were expressed as mean, standard deviation and median for continuous and number with percentage for categorical data. Chi square test was applied to measure differences and significance was taken at p value < 0.05.

Results:

One hundred and twenty–five patients were operated for pituitary adenoma. Sixty–three percent were male and mean age was 37 years. Sixty percent of the patients presented with headache and/or visual symptoms. Twelve percent presented with pituitary apoplexy and 28% presented with symptoms due to pituitary hyperfunction. Fifty–five percent of patients had functioning and 44% had nonfunctioning adenomas. Mean pre operative tumor diameter from 86 pre op MRI scans was 26.76 mm (3–78 mm). Eighty–four percent of patients underwent trans–sphenoidal tumor resection and three percent had craniotomy. Mean size of post op residual tumor as calculated from 76 available post operative scans was 5.3 mm (range 0–31 mm). 17.6% of the patients required hormone replacement beyond three months and 10% were re–operated. Overall mortality was 1.6%.

Conclusion:

In Pakistan, patients are more likely to present either with apoplexy or with a giant pituitary adenoma than patients reported from developed countries. Overall, our results have been satisfactory and comparable with the literature.

Résumé:

<span class='bold'>RÉSUMÉ:</span><span class='bold'><span class='italic'>Objectif:</span></span>

Le but de cette revue rétrospective de tous les cas d’adénomes pituitaires opérés au cours de la dernière décennie était de définir le profil démographique et les caractéristiques de ces tumeurs et d’évaluer les résultats chirurgicaux en termes de sécurité et d’efficacité de l’ablation trans–sphénoïdale de la tumeur dans notre institution.

<span class='bold'><span class='italic'>Méthodes:</span></span>

Nous avons révisé les observations de patients qui ont subi une chirurgie pour adénome pituitaire entre 1995 et 2005. La moyenne, la déviation standard et la médiane ont été calculées pour les variables continues et le pourcentage pour les variables discrètes. Le test du chi–carré a été utilisé pour l’analyse des données et la valeur de p a été fixée à < 0,05.

<span class='bold'><span class='italic'>Résultats:</span></span>

Cent vingt–cinq patients ont subi une chirurgie pour un adénome pituitaire. L’âge moyen était de 37 ans et 63% étaient des hommes. Soixante pour cent des patients ont consulté initialement pour de la céphalée et/ou des symptômes visuels, 12% pour apoplexie pituitaire et 28% pour des symptômes d’hyperpituitarisme. Chez 55% des patients l’adénome était fonctionnel et chez 44% l’adénome ne l’était pas. Le diamètre moyen de la tumeur avant la chirurgie, évalué au moyen de 86 IRM préopératoires, était de 26,76 mm (3 à 78 mm). Quatre–vingt–quatre pour cent des patients ont subi une résection trans–sphénoïdale de la tumeur et 3% ont subi une craniotomie. La taille moyenne de la tumeur résiduelle en postopératoire, calculée au moyen de 76 scans effectués après la chirurgie, était de 5,3 mm (0 à 31 mm). Un remplacement hormonal s’est avéré nécessaire chez 17,6% des patients au–delà de trois mois et on a dû réintervenir chez 10%. La mortalité globale a été de 1,6%.

<span class='bold'><span class='italic'>Conclusion:</span></span>

Au Pakistan, les patients consultent plus souvent pour une apoplexie pituitaire ou un adénome géant que dans les pays développés. Dans l’ensemble, nos résultats ont été satisfaisants et ils sont comparables à ceux rapportés dans la littérature.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 2 , May 2008 , pp. 198 - 203
Copyright
Copyright © The Canadian Journal of Neurological 2008

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