.2001 Cases Of Surgical Treatment Of Pituitary Tumors In Patients With Clinical Analysis

Objective:To analyze the clinical manifestations,image characteristics, endocrine finding,pathological type of pituitary adenoma,and to evaluate the therapeutic effects and side effects of the surgical treatment on pituitary adenomas.Methods:Two thousand and one patients were operated on in Huashan Hospital between January,2005 and December,2007 for pituitary adenoma and were analyzed retrospectively.The data were analyzed by SPSS 11.5 software.Results:2001 patients were diagnosed pituitary adenoma before operation. There were 947 males and 1054 females.The median age is 42.The most frequent pathological type was nonfunctioning adenoma(NFPA)(41.6%), followed by prolactin(PRL)-secreting adenoma(24.7%),growth hormone (GH)-secreting adenoma(10.1%) and follicle-stimulating hormone (FSH)-secreting adenoma(9.2%).There were more females than males with PRL-secreting adenoma(P＜0.01) whereas less females than males with FSH-secreting adenoma(P＜0.01).The most incidence is at age 30 - 60 years; clinical presentation is earlier in female than in male,especially patients with PRL-secreting adenoma(P＜0.01).Clinical manifestations:935 patients(46.7%) complained of compressive symptoms(e.g.headache,decrease of vision).716 patients (35.8%) complained of the symptoms caused by excessive hormone(e.g. menstrual disorder,galactorrhea,acromegaly) while 40 patients(2.0%) complained of the symptoms caused by hormonoprivia(e.g.dysplasia).182 patients(9.1%) were found residual adenoma or recurrence after surgery or radiosurgery.84 patients(4.2%) were incidentaloma,42 patients(2.1%) complained of others。In the patients whose image showed tumor size,there were 99 cases of microadenoma(10.7%) and 827 cases of macroadenomas(89.3%).The male female ratio was different in PRL microadenoma and PRL macroadenoma,which were more females in PRL microadenoma,while the ratio was nearly same in PRL macroadenoma.The tumor invaded chiasm opticum in 334 patients (19.5%) and cavernous sinus in 244 patients(14.2%).In the patients whose chiasm opticum were invaded,the coincidence between clinical manifestation and image characteristics was only 55.76%.Hormone level:Hyperprolactinaemia could be found in most PRL-secreting adenomas,while some were normal.We noticed that hyperprolactinaemia could also be found in the other types of pituitary adenomas besides PRL-secreting adenoma,but serum levels of PRL were obviously less than that of PRL-secreting adenoma,and the tumor' s size was obviously bigger than that of PRL-secreting adenoma.The PRL was related moderately with tumor size and little with age,in the patients of PRL-secreting adenoma.Patients with PRL-secreting adenoma exhibited significantly reduced postoperative PRL levels(P＜0.05).And patients with GH-secreting adenoma exhibited significantly reduced postoperative GH levels(P＜0.05),too.The rate of total removal of the tumors was 82.2%,mortality was 0.7%o 1785 patients(89.2%) were treated with transsphenoidal surgery. Transsphenoidal surgery had more complications of nasal part,and fewer complications of cranial nerve injury,diabetes insipidus,electrolyte disturbances,and so on.The incidences rate of cerebral hemorrhage and electrolyte disturbances were higer in tumors partly removed than totally removed.Microadenoma had less complications than macroadenoma after surgery,but it' s no statistical significance.Conclusion:The most frequent pathological type was NFPA,followed by PRL-secreting adenoma and GH-secreting adenoma.Patients complained of compressive symptoms more than symptoms caused by excessive hormone. Surgery could relieve the high hormone level,transsphenoidal surgery had little complications and low mortality.However,surgery could cause hypopituitarism,so it' s necessary to follow the hormone levels after surgery.Substituet should be given once the patient was diagnosed hypopituitarism.