Long-term results of neurosurgical treatment inactive pituitary adenomas

Relevance. Dynamic assessment of visual functions, symptoms of physical failure and the study of cycles of inactive pituitary adenoma (IPA) taking into account visualization indicators of general clinical, ophthalmological, hormonal patients with a verified diagnosis after transsphenoidal transnasal adenomectomy is of great importance for the further choice of treatment tactics and management of these patients. The purpose of our study was to dynamically assess visual functions, symptoms of pituitary insufficiency and study the frequency of relapses of inactive pituitary adenoma (IPA) taking into account general clinical, ophthalmological, imaging, hormonal parameters of patients with a verified diagnosis who applied to the Russian Scientific and Practical Medical Center for Endocrinology after transsphenoidal transnasal adenomectomy. Material and methods. 188 case histories of patients with IPA operated on from 2018 to 2022 were retrospectively analyzed. The diagnosis of IPA was verified using imaging methods and data from studying the hormonal status of patients. Observation of patients after the first operation ranged from 1 to 3 years. Of the 188 patients, 61 (32.4%) were men and 127 (67.6%) were women. 151 patients had macroadenoma (up to 40 mm), the remaining 37 had giant tumor sizes (any size greater than 40 mm). Results. Аfter adenomectomy in the long term after surgery, 36.1% of patients with IPA show an improvement in visual functions, 16.5% of patients who had normoprolactinemia before surgery show moderate hyperprolactinemia; In 50% of patients, erectile dysfunction is restored while taking cabergoline drugs in combination with hormone replacement therapy, but at the same time, the number of patients with total hypopituitarism (29.3%) and with a permanent form of diabetes insipidus (up to 30.7%) is increasing. An increase in hypopituitarism, the need for hormone replacement therapy with glucocorticoids, thyroid and sex hormones in 90% of patients, and desmopressin in 30.7% requires constant endocrinological monitoring of patients after surgery. Conclusion. After neurosurgical treatment, it is necessary to control the level of tropic hormones of the pituitary gland, the level of PRL and hormones of the peripheral endocrine glands in the blood (cortisol, free cortisol in daily urine, free thyroxine, testosterone in men and estradiol in women (with an irregular menstrual cycle, with a regular one - inappropriate) , as well as a urine test according to Zimnitsky for the diagnosis of diabetes insipidus.