VISUAL ASSESSMENT AND QUALITY OF LIFE IN PATIENTS SUBMITTED TO SURGERY FOR SUPRASELLAR PITUITARY ADENOMA WITH VISUAL DEFICITS

• Grant number: 24/08070-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: September 01, 2024
• End date: August 31, 2025
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Samuel Tau Zymberg
• Grantee: Bruno Pellozo Cerqueira
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

INTRODUCTION: Pituitary adenoma (PA), a common benign tumor, accounts for 16.7% of primary central nervous system tumors in the USA. Adenomas can be microadenomas, macroadenomas or giant adenomas, with significant impacts on vision due to their proximity to the optic chiasm. This study aims to evaluate visual deficits and quality of life in patients with PA, focusing on a quaternary hospital setting in Brazil, an area that has not yet been explored in national data. OBJECTIVES: To evaluate the epidemiological, clinical and surgical profile of patients operated on for PA with suprasellar extension with visual deficits, focusing on comparing the data of patients who had an improvement in their visual condition after surgery with those who remained visually impaired; To evaluate the quality of life of patients with PA with suprasellar extension with visual deficits, applying the SF-36 questionnaire at 2 points in time: preoperatively and 6 months after surgery; To evaluate patients with PA with suprasellar extension with visual deficits who were referred to Hospital São Paulo as an emergency. METHODS: The study methodology consists of two branches with patients with suprasellar pituitary adenomas operated on at Hospital São Paulo between 2015 and 2025. The retrospective arm includes patients who have already undergone surgery, while the prospective arm includes those who have not yet undergone surgery. The exclusion criteria are age under 18, a negative anatomopathological result for pituitary adenoma and the absence of computerized campimetry. The data collected and analyzed includes demographic information and general physical examination (age, ethnicity, gender, place of residence, origin, profession and Body Mass Index - BMI), clinical data (symptoms of the clinical presentation, such as visual symptoms, headache and endocrine symptoms such as acromegaly, hyperthyroidism, Cushing's disease, hyperprolactinemia and hypergonadotropic hypogonadism, as well as incidentalomas), duration of the disease (dates of first symptoms, first consultation with a specialist, first imaging test, first laboratory test and surgery) and associated comorbidities. Laboratory tests will be taken, including dosages of hormones such as FSH, LH, prolactin, IGF-1, TSH, T4, testosterone, estradiol and cortisol (blood and urine). Imaging tests of the pituitary gland, such as magnetic resonance imaging with gadolinium, will be used to assess the size of the tumor, its location in relation to the sella turcica, the degree of compression of the optic chiasm using the Fujimoto scale, the degree of invasion of the cavernous sinus using the Knosp classification, contrast uptake and the presence of hemorrhage, infarction or apoplexy. Ophthalmological examinations will include visual acuity assessment, confrontation campimetry and computerized campimetry, as well as optical coherence tomography, if available. Surgical data will be collected, such as the access route to the sella turcica, complications during surgery and the occurrence of intra- or post-operative fistulas. The anatomopathological analysis of the surgical specimen will include cytological analysis, immunohistochemistry and immunopathological diagnosis. The evolution of symptoms will be analyzed after surgery in specific periods, such as the immediate postoperative period, 3 months, 6 months, 1 year and the last follow-up visit, whenever possible on these dates. In the prospective arm, a quality of life questionnaire (Short Form Health Survey 36 - SF-36) will be applied preoperatively and 6 months after surgery. In the retrospective group, if the patient has completed the questionnaire, the data will be collected.