Trans-Sphenoidal Endoscopic Approach in Pituitary Adenomas: Clinical and Laboratory Outcome Analysis of a Single Center

Introduction. Pituitary adenomas constitute the second most frequent neoplasm of the central nervous system and despite the often-indolent behavior of these tumors, patients affected by pituitary adenomas show higher morbidity and mortality rates. Surgery offers good results in terms of symptoms and disease control: the aim of this study was to evaluate how the neurosurgical treatment for the removal of a pituitary adenoma through a trans-sphenoidal approach can modify the patient's hormonal panel and its influence on the overall clinical outcome. Materials and methods. Between January 2018 and September 2021, 69 patients who underwent surgery for pituitary adenoma operated via the trans-sphenoidal approach were enrolled in the study. Clinical and laboratory data included pre- and post-operative hormonal status, assessed before surgery and within the following 48 hours. Results. Remission of endocrinological values outside physiological ranges and resolution of symptoms were considered as favorable outcome. Surgical treatment was statistically significant as factor to normalize the following hormones: ACTH (p = 0.014), TSH (p lt; 0.0001), fT3 (p lt; 0.0001), fT4 (p lt; 0.0001), FSH (p lt; 0.0001), LH (p = 0.001), testosterone (p = 0.001), prolactin (p lt; 0.0001), confirming previous literature findings. Furthermore, the association between surgery and resolution of pre-operative visual disturbances was statistically significant (p lt; 0.0001). Overall, 59% of patients experienced complete or partial remission of the pre-operative endocrinological abnormalities and in 76% their initial symptoms improved. Conclusions. This study confirms, in our experience, the excellent risk-benefit ratio supporting the use of trans-sphenoidal endoscopic surgery as an effective therapeutic approach for the removal of pituitary adenomas with improvement in the post-operative hormonal and clinical status.