Trabalhos Aprovados

Incidence of Adrenal Insufficiency and Diabetes Insipidus Following Trans-sphenoidal Surgery for Sellar Lesions



Autor(es): Juan-Cantu-Clatza@ouhsc.edu; Lim J; Alhyari L;
Apresentador(a): Juan Antonio Cantu-Clatza

Introduction: Diabetes insipidus (DI) and adrenal insufficiency (AI) are common complications in patients undergoing trans-sphenoidal surgery (TSS). TSS approach is the surgical method of choice for treatment of sellar lesions and has shown advantages such as quicker recovery and fewer complications compared to traditional approach.

Objective: To determine the incidence of AI and DI following TSS approach for sellar lesions and the incidence of secreting versus non-secreting adenomas in our institution.

Methods: The pre-operative, perioperative and post-operative records of patients who underwent TSS under the care of one neurosurgeon were reviewed retrospectively during a 5-year period. Pre-operative tumor size and invasion to cavernous sinus along with chemical and histological evaluation of lesions were evaluated. Fischer Exact‘s test was performed to assess the association between the secretory status of sellar lesions and the incidence of AI and DI.

Results: Our study included 101 patients (58% female, mean age 48.9 years). Pituitary lesions shown a mean KI-67 index of 2.05 with 87.1% of adenomas having imaging features of cavernous sinus invasion and mean size of 1.64 x 2.0 x 1.89 cm. The overall incidence of immediate DI was 66.6%, with 66 % of those patients requiring desmopressin at discharge. The overall incidence of permanent DI was 12.4% of patients who underwent TSS. The incidence of permanent DI in patients with non-secretory lesions was 13.3% vs. 7.1% on those with a secretory lesion (P=1.00). AI was found in 25 patients accounting 28.1% of patients who underwent TSS. The incidence of permanent AI was 30.3% among patients with non-secretory lesions versus 15.4% among those with secretory lesions (P=0.33). From the overall study population, 16 patients had a secretory lesions (15.8%), 9 were prolactin secreting (56%), 4 GH (25%), 2 ACTH secreting (12%) and 1 mixed prolactin-GH secreting (6%).

Conclusion: Endocrine function evaluation prior a TSS is mandatory as pituitary lesions have the potential to disrupt hypothalamic-pituitary axis. Predisposing factors that affected the rate of complications included lesion size, adherence of lesion to surrounding structures and histopathologic features. Based on our institutional analysis the incidence of permanent central AI and DI after a TSS is comparable to incidence reported in literature, also showed a higher incidence of permanent complications in non-secretory lesions.

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