====== Hypopituitarism after surgery ======

[[Recovery]] from preexisting [[hypopituitarism]] after [[transsphenoidal surgery]] for [[pituitary neuroendocrine tumor]] is an important [[outcome]] to investigate. Furthermore, the [[pituitary]] function has not been thoroughly evaluated after fully [[endoscopic surgery]], and [[benchmark]] outcomes have not been clearly established. 

Little et al. characterized [[pituitary gland]] outcomes with a focus on gland recovery following [[endoscopic transsphenoidal]] [[removal]] of [[clinically nonfunctioning pituitary neuroendocrine tumor]]s.

This [[multicenter]] [[prospective study]] was conducted at 6 US pituitary centers among adult patients with nonfunctioning [[pituitary macroadenoma]]s who had undergone [[endoscopic endonasal]] pituitary surgery. [[Pituitary gland function]] was evaluated 6 months after surgery.

The 177 enrolled patients underwent fully [[endoscopic transsphenoidal]] [[surgery]]; 169 (95.5%) of them were available for follow-up. Ninety-five (56.2%) of the 169 patients had had a preoperative deficiency in at least one hormone axis, and 20/95 (21.1%) experienced recovery in at least one axis at the 6-month follow-up. Patients with [[adrenal insufficiency]] were more likely to recover (10/34 [29.4%]) than were those with [[hypothyroidism]] (8/72 [11.1%]) or male [[hypogonadism]] (5/50 [10.0%]). At the 6-month follow-up, 14/145 (9.7%) patients had developed at least one new deficiency. The study did not identify any predictors of gland recovery (p ≥ 0.20). Permanent [[diabetes insipidus]] was observed in 4/166 (2.4%) patients. Predictors of new gland dysfunction included a larger tumor size (p = 0.009) and [[Knosp grade 3]] and [[Knosp grade 4]] (p = 0.051).

Fully endoscopic pituitary surgery resulted in the improvement of pituitary gland function in a substantial minority of patients. The deficiency from which patients were most likely to recover was [[adrenal insufficiency]]. Overall rates of postoperative permanent [[diabetes insipidus]] were low. This study provides multicenter benchmark neuroendocrine clinical outcome data for the endoscopic technique
((Little AS, Gardner PA, Fernandez-Miranda JC, Chicoine MR, Barkhoudarian G,
Prevedello DM, Yuen KCJ, Kelly DF; TRANSSPHER Study Group. Pituitary gland
recovery following fully endoscopic transsphenoidal surgery for nonfunctioning
pituitary neuroendocrine tumor: results of a prospective multicenter study. J Neurosurg. 2019 
Nov 15:1-7. doi: 10.3171/2019.8.JNS191012. [Epub ahead of print] PubMed PMID:
31731279.
)).