"Factors affecting the prognosis of the surgical treatment of non-secreting pituitary adenomas."

• Grant number: 24/17758-8
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: January 01, 2025
• End date: December 31, 2025
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Adriano Yacubian Fernandes
• Grantee: Ana Clara Toschi Aquino
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

The pituitary adenomas are benign intracranial tumors that affect the health and life quality of patients, due to hormonal and compression effects. They can be divided in non-secreting or hormone-secreting tumors: the most frequent hormone-secreting tumors are the growth hormone-producing ones, causing acromegaly and gigantism, the adrenocorticotropic-producing ones, causing Cushing's disease, and the prolactin-producing ones, the prolactinomas. The non-hormone secreting tumors can lead to hypopituitarism. The treatment of prolactinomas is eminently clinical, using dopaminergic agonists, while the other adenomas, hormone-secreting and non-hormone secreting, are treated eminently surgically, and the first choice treatment is the transsphenoidal endoscopy in most cases.The non-hormone secreting adenomas (NHSA) are the focus of this study, and they can be completely silent, when there is no hormonal hypersecretion, there is asymptomatic hormonal hyper or hyposecretion. The neurological effects of these tumors are mostly "mass effects", due to the adjacent structures compression, such as the optic chiasm and the III, IV, V and VI cranial nerves. There can also be headaches and apoplexy.The pituitary adenomas can be divided into macroadenomas, when they measure more than 1 centimeter in diameter, or microadenomas, when they measure less than a centimeter. The macroadenomas can cause visual changes for compressing the optic chiasm, and bitemporal hemianopsia is the most common finding. In cases of pituitary apoplexy, the visual loss can be sudden and surgical intervention is emergent. The preferred surgical approach for this type of tumor is the endoscopic transsphenoidal associated with microscopy. The transcranial approach is reserved for macroadenomas with an important sellar and suprasellar invasion, according to Knosp's classification. Among the surgical complications of these procedures are liquor fistulas, meningitis, diabetes insipidus, worsened visual loss, and tumoral bed bleeding. The unfavorable outcome occurs when tumor resection is incomplete or when mortality is related to the surgical intervention.The objective of this study is to analyze the factors related to prognosis in the surgical treatment of pituitary adenomas.For that, the method will be to analyze the casuistic of pituitary adenomas (retrospective longitudinal study) operated in a reference University Hospital, considering preoperative imaging aspects (tumor size, cavernous sinus invasion and optic chiasm compression), the patient's endocrinologic diagnosis (Cushing's disease, acromegaly, prolactinomas and non-secretive tumors