Follow-up Of 189 Cases Of Pituitary Adenoma After Surgery

Pituitary Adenoma is one of the commonest intracranial tumors. With the popularization of imaging and endocrine hormone examination, its detection rate is significantly increased year by year.Surgery is the first choice for functional pituitary adenomas and nonfunctioning macroadenomas except prolactinomas. Regular monitoring of endocrine hormone and MRI scan for lifelong are suggested for the patients with pituitary adenoma.189 patients with pituitary adenoma after surgery were recruited (83 male,106 female). The median age was 53. The group at regular follow-up was at age 50-60 years. The most common pathological type was nonfunctioning pituitary adenoma (NFPA) (45.5%), followed by prolactinomas (17.5%), growth hormone (GH)-secreting adenoma and follicle-stimulating hormone (FSH)-secreting adenoma (both 11.6%). There were 31 cases of microadenomas(<1cm),150 cases of macroadenomas (>1cm) and 8 cases of huge adenomas (>4cm).41.8% patients complained of one or more than one symptom, such as fatigue (25.9%), poor appetite (13.8%), low libido (15.3%), feeling cold(14.3%).72.5% of the patients were well-controlled after first operation, while 21.5% with tumor residue and 5.8% with recurrence.41.3% patients were diagnosed with pituitary hypofunction, with 31.7% in adrenal axis,31.2% in thyroid axis and 27% in gonadal axis. The function of anterior pituitary had correlation with age (r=0.246, P=0.001), time (r=0.157, P=0.031) and the size of tumor (r=0.143, P=0.049). Patients who got clinical symptoms had a lower rate of tumor control and a higher rate of hypofunction than the others who had not (P<0.05).4.8% patients had the permanent central diabetes insipidus.Only 21.2% of the patients had regular follow-up after surgery. The results showed that the patients who had tumor residue, tumor recurrence, hypopituitarism and clinical symptom were more likely to follow up regularly(P<0.05).74.5% of the patients without regular follow-up had been well-controlled after first surgery, while 20.8% with tumor residue and 4.7% with tumor recurrence. In this group,35.6% patients were found to have pituitary hypofunction and they had a lower rate of corresponding hormone replacement treatment than the patients with regular follow-up (P<0.05)Adult Growth Hormone Deficiency (AGHD) is the most common hormone deficiency in patients with surgery of pituitary adenoma, which has negative effects on visceral fat, blood lipid, cardiovascular risk factors, quality of life and osteoporosis. The insulin tolerance test (ITT) is the gold standard for diagnosing AGHD. The ITT was performed in 17 pituitary adenoma patients after operation. Only two patients had normal GH response, with fifteen severe deficient together with two or more than two kinds of pituitary hormone deficiency in majority. GH deficiency had no correlation with age and the size of tumor (P>0.05).In a word, it is necessary and urgent to follow up regularly.