Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website http://www.jofem.org |
Original Article
Volume 7, Number 4, August 2017, pages 122-130
In-Hospital Postoperative Complications in Patients With Pituitary Adenoma Who Underwent Pituitary Surgery From January 2010 to December 2015: A Multicenter Study
Tables
Characteristics of patients | Mean | SD | f(%) |
---|---|---|---|
Hormonal evaluation | |||
Level of ACTH (pg/mL) | 95.80 | 113.43 | 2 (2.8%) |
Level of cortisol (nmol/L) | 450.46 | 1,222.89 | 55 (77.5%) |
Level of LH (mIU/mL) | 6.62 | 9.54 | 4 (5.6%) |
Level of FSH (mIU/mL) | 10.45 | 17.25 | 6 (8.5%) |
Level of TSH (µIU/mL) | 1.25 | 0.94 | 46 (64.8%) |
Level of free T4 (pmol/L) | 12.61 | 5.25 | 40 (56.3%) |
Level of T4 (nmol/L) | 79.09 | 31.51 | 14 (19.7%) |
Level of free T3 (pmol/L) | 3.32 | 1.18 | 10 (14.1%) |
Level of T3 (nmol/L) | 1.62 | 0.82 | 8 (11.3%) |
Level of prolactin (mIU/L) | 6,606.22 | 24,043.57 | 41 (57.7%) |
Level of growth hormone (ng/mL) | 15.35 | 21.56 | 2 (2.8%) |
Level of testosterone (ng/mL) | 1.55 | 1.40 | 4 (5.6%) |
Level of estradiol (pg/mL) | 19.13 | 9.48 | 2 (2.8%) |
Neuroradiological evaluation | |||
Size of the tumor | 67 (94.4%) | ||
Length | 2.31 | 0.89 | |
Width | 2.44 | 0.95 | |
Height | 2.66 | 1.30 | |
Tumor invasion | |||
Hardy grading classification | - | - | |
Non-invasive (GRADE 0A-2E) | - | - | 33 (46.5%) |
Invasive (GRADE 3A-4E) | - | - | 35 (49.3%) |
Unspecified | - | - | 3 (4.2%) |
KNOSP grading classification | - | - | |
Non-invasive (GRADE 0-2) | - | - | 43 (60.6%) |
Invasive (GRADE 3-4) | - | - | 25 (35.2%) |
Unspecified | - | - | 3 (4.2%) |
Surgical management | |||
Trans-sphenoidal surgery | - | - | 32 (45.1%) |
Indications for trans-sphenoidal surgery | |||
Visual compromise | - | - | 24 (75%) |
Treatment failure | - | - | 2 (6.3%) |
ACTH-secreting | - | - | 1 (3.1) |
GH-secreting | - | - | 1 (3.1%) |
Not determined | - | - | 4 (12.5%) |
Trans-cranial surgery | - | - | 39 (54.9%) |
Indications for transcranial surgery | |||
Visual compromise | - | - | 33 (84.6%) |
Tumor recurrence | - | - | 4 (10.3) |
Others | - | - | 2 (5.1%) |
Final histopathology report | - | - | |
Pituitary adenoma | - | - | 67 (94.3%) |
Pituitary adenoma with hemorrhage | - | - | 4 (5.6%) |
Complications | Transcranial (n = 39) | TSS (n = 32) | All (n = 71) | P-value |
---|---|---|---|---|
No. of patients with any complication | 12 (30.7%) | 11 (34.4%) | 23 (32.4%) | 0.747 |
Identified complications | ||||
Diabetes insipidus | 10 (25.6%) | 6 (18.8%) | 16 (22.5%) | 0.344 |
Transient | 6 (15.4%) | 6 (18.8%) | 12 (16.9%) | |
Undetermined (until discharge) | 4 (10.3%) | 0 (0%) | 4 (5.6%) | |
Transient CSF leak | 2 (5.1%) | 3 (9.4%) | 5 (7%) | 0.405 |
Hemorrhage | 4 (10.3%) | 2 (6.3%) | 6 (8.5%) | 0.436 |
Subarachnoid | 2 (5.1%) | 2 (6.3%) | 4 (5.6%) | |
Subdural | 1 (2.6%) | 1 (1.4%) | ||
Focal | 1 (2.6%) | 1 (1.4%) | ||
Worsening of vision | 1 (2.6%) | 1 (3.1%) | 2 (2.8%) | 0.887 |
Headache | 1 (2.6%) | 1 (3.1%) | 2 (2.8%) | 0.887 |
Obstructive hydrocephalus | 2 (5.1%) | 0 (0%) | 2 (2.8%) | 0.194 |
Seizure | 2 (5.1%) | 0 (0%) | 2 (2.8%) | 0.194 |
Hospital-acquired pneumonia | 1 (2.6%) | 0 (0%) | 1 (1.4%) | 0.194 |
Death | 1 (2.6%) | 1 (3.1%) | 2 (2.8%) | 0.702 |
Variables | No complications (n = 48) | With complications (n = 23) | P-value | ||
---|---|---|---|---|---|
N (%) | Mean (SD) | N (%) | Mean (SD) | ||
Demographics | |||||
Age years | 43 (100%) | 44.09 (14.36) | 28 (100%) | 42.82 (14.17) | 0.715 |
Elderly ≥ 60 years old | 6 (12.5%) | 2 (7.1%) | 0.635 | ||
Sex | - | - | 0.399 | ||
Females | 26 (54.2%) | 10 (35.7%) | |||
Males | 22 (45.8%) | 13 (46.4%) | |||
Presence of co-morbidities | 20 (41.7%) | - | 9 (32.1%) | - | 0.839 |
With previous pituitary surgery | 3 (6.3%) | - | 2 (8.7%) | - | 0.706 |
Clinical presentation | |||||
Presence of headache | 22 (45.8%) | 18 (78.3%) | 0.009 | ||
Visual disturbances | 37 (77.1%) | 20 (86.9%) | 0.3278 | ||
Nausea and vomiting | 2 (4.2%) | 3 (13%) | 0.1713 | ||
Signs and symptoms of hypogonadism | 4 (8.3%) | 3 (13%) | 0.533 | ||
Other signs and symptoms | 8 (1.7%) | 1 (4.3%) | 0.1443 | ||
Microadenoma | 5 (10.4%) | 0 (0%) | 0.108 | ||
Giant adenoma | 10 (20.8%) | 4 (17.4) | 0.733 | ||
Hypopituitarism | 22 (45.8) | 9 (39.1) | 0.594 | ||
Hormonal evaluation | |||||
Level of cortisol | 35 (81.4%) | 335 (543.86) | 20 (71.4%) | 651.95 (1,911.49) | 0.360 |
Level of TSH | 30 (69.8%) | 1.23 (1.04) | 16 (57.1%) | 1.27 (0.72) | 0.888 |
Level of prolactin | 23 (53.5%) | 4,760 (16,891) | 18 (64.3%) | 8,965.3 (31,312.8) | 0.585 |
Neuroradiological evaluation | |||||
Size of the tumor | |||||
Length | 48 (100%) | 2.28 (0.98) | 19 (82.6%) | 2.36 (0.75) | 0.734 |
Width | 48 (100%) | 2.3 (0.94) | 19 (82.6%) | 2.64 (0.96) | 0.151 |
Height | 48 (100%) | 2.68 (1.43) | 18 (82.6%) | 2.63 (1.1) | 0.881 |
Tumor invasion | |||||
Invasive Hardy grade | |||||
Invasive (n = 35) | 24 (50%) | - | 11 (47.8%) | - | 0.8639 |
Invasive Knosp grade | |||||
Invasive (n = 25) | 18 (31.3%) | - | 7 (30.4%) | - | 0.5597 |
Surgical management | |||||
Trans-sphenoidal surgery | 21 (43.8%) | - | 12 (52.2%) | - | 0.405 |
Transcranial surgery | 27 (56.3%) | - | 11 (47.8%) | - | 0.086 |
Variables in the equation | B | SE | P-value | OR | 95% CI | |
---|---|---|---|---|---|---|
Lower | Upper | |||||
Age | -0.002 | 0.022 | 0.929 | 0.998 | 0.956 | 1.042 |
Sex, males | 0.737 | 0.618 | 0.233 | 2.091 | 0.622 | 7.026 |
Headache | 0.629 | 0.587 | 0.284 | 1.875 | 0.594 | 5.924 |
Visual disturbance | -0.906 | 0.938 | 0.334 | 0.404 | 0.064 | 2.539 |
Signs and symptoms of hypogonadism | -0.315 | 1.022 | 0.758 | 0.73 | 0.098 | 5.41 |
Size of tumor length | -0.316 | 0.53 | 0.551 | 0.729 | 0.258 | 2.06 |
Size of tumor width | 1.601 | 0.675 | 0.018 | 4.959 | 1.32 | 18.624 |
Size of tumor height | -0.9 | 0.492 | 0.067 | 0.407 | 0.155 | 1.066 |
Trans-sphenoidal surgery | 0.187 | 0.658 | 0.776 | 1.206 | 0.332 | 4.381 |
Constant | -0.978 | 1.45 | 0.500 | 0.376 |