A new study recently published by researchers at the Universities of Cambridge and London presents the clinical outcome of surgical treatment of pituitary adenomas.
The pituitary gland is a small gland located at the base of the skull, just below the optic nerves. It secretes hormones that transmit messages throughout the body and therefore controls other glands such as the thyroid, adrenals, and reproductive organs. Pituitary tumors are among the most common brain tumors. Most of them are benign (non-cancerous). Adenomas are the most common pituitary tumor, with recent studies estimating that they affect 1 in 1,000 people. Other, less common, pituitary tumors are craniopharyngioma, Rathke cyst, meningioma, germinoma, etc.
The study, as a systematic literature review, included 178 primary studies and a total of 427,659 patients. It was published, in fact, in the main medical journal specializing in the Pituitary gland (Pituitary, official journal of the World Pituitary Society). As reported by the head of the study, neurosurgeon director of Cambridge University Hospital and member of the scientific team at the 1st Henriques Dunan Neurosurgery Clinic, Angelos Kolias, pituitary adenomas can cause a multitude of symptoms either due to pituitary hypofunction (with symptoms such as fatigue, hypotension, weight gain, decreased muscle mass, infertility, reduced libido, erectile dysfunction, etc.) or hypersecretion of specific hormones that lead to diseases such as megalacria, Cushing’s disease, etc. Tumors that exert pressure on the optic nerves cause loss of visual fields and/or decreased visual acuity that can, without timely intervention, lead to blindness. Diagnosis is made by MRI of the brain. However, multidisciplinary evaluation is necessary to determine whether the adenoma affects vision or pituitary function.
According to the study, surgical excision is the main method of treating pituitary adenomas and, for this reason, it is essential that both doctors and patients emphasize clinical results, namely:
– Surgical complications (bleeding, leakage of cerebrospinal fluid, infection, etc.).
– Postoperative pituitary hypofunction
– Postoperative remission of the disease (for secretory tumors).
– Improved postoperative vision.
– Postoperative deterioration of vision.
– Any residual tumor.
– Tumor recurrence.
– Nasal complications (congestion, reduced sense of smell, etc.).
– Quality of life.
According to Kolia, surgical removal of pituitary adenomas is performed using minimally invasive techniques using an endoscope via the transnasal and transsphenoidal route. The operation is extremely safe and effective, as long as it is carried out by neurosurgeons with the necessary knowledge and experience.
The excellent safety lies in the fact that the possibility of serious complications such as intraoperative death, stroke or injury to the internal carotid arteries is almost eliminated. In terms of efficacy, the study demonstrates that surgery should aim to achieve its objectives (i.e. improvement or prevention of deterioration of vision, if possible radical tumor exclusion, postoperative disease remission for secretory tumors) and minimize the potential for complications (i.e., bleeding, cerebrospinal fluid spill, infection, postoperative hypopituitarism, postoperative visual impairment, nasal complications). Maintaining patients’ quality of life is extremely important and depends, to a large extent, on avoiding new hormonal disorders in the postoperative period, on excellent regulation of possible hormonal disorders (pre- and postoperative) and on avoiding nasal complications.
For these reasons, explains the person responsible for the study, in the main centers worldwide there are multidisciplinary Pituitary Teams, made up of neurosurgeons, endocrinologists, neuro-ophthalmologists and neuroradiologists. Furthermore, in the main centers around the world, in operations of this type, in addition to the neurosurgeon, an ENT surgeon also participates, as access is through the nose. These specialized teams have the knowledge, experience and technology to:
– the correct diagnosis is made and the correct treatment plan is agreed without unnecessary delay
– the chances of long-term cure or control of the tumor are maximized, maintaining quality of life
– the chances of complications are minimized.
As Kolias highlights, the Interdisciplinary Pituitary Team, which operates in the First Neurosurgery Clinic of the Henry Dunan Hospital Center, is capable of offering high-quality health services to all patients with tumors and other pituitary diseases, from the first moment of identification the problem, during immediate treatment, but also during long-term treatment.