J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website http://www.jofem.org

Original Article

Volume 7, Number 4, August 2017, pages 122-130

In-Hospital Postoperative Complications in Patients With Pituitary Adenoma Who Underwent Pituitary Surgery From January 2010 to December 2015: A Multicenter Study

**Table 1.** Hormonal and Neuroradiological Evaluation and Surgical Management of Patients With Pituitary Adenoma
Characteristics of patients	Mean	SD	f(%)
Hormonal evaluation
Level of ACTH (pg/mL)	95.80	113.43	2 (2.8%)
Level of cortisol (nmol/L)	450.46	1,222.89	55 (77.5%)
Level of LH (mIU/mL)	6.62	9.54	4 (5.6%)
Level of FSH (mIU/mL)	10.45	17.25	6 (8.5%)
Level of TSH (µIU/mL)	1.25	0.94	46 (64.8%)
Level of free T4 (pmol/L)	12.61	5.25	40 (56.3%)
Level of T4 (nmol/L)	79.09	31.51	14 (19.7%)
Level of free T3 (pmol/L)	3.32	1.18	10 (14.1%)
Level of T3 (nmol/L)	1.62	0.82	8 (11.3%)
Level of prolactin (mIU/L)	6,606.22	24,043.57	41 (57.7%)
Level of growth hormone (ng/mL)	15.35	21.56	2 (2.8%)
Level of testosterone (ng/mL)	1.55	1.40	4 (5.6%)
Level of estradiol (pg/mL)	19.13	9.48	2 (2.8%)
Neuroradiological evaluation
Size of the tumor			67 (94.4%)
Length	2.31	0.89
Width	2.44	0.95
Height	2.66	1.30
Tumor invasion
Hardy grading classification	-	-
Non-invasive (GRADE 0A-2E)	-	-	33 (46.5%)
Invasive (GRADE 3A-4E)	-	-	35 (49.3%)
Unspecified	-	-	3 (4.2%)
KNOSP grading classification	-	-
Non-invasive (GRADE 0-2)	-	-	43 (60.6%)
Invasive (GRADE 3-4)	-	-	25 (35.2%)
Unspecified	-	-	3 (4.2%)
Surgical management
Trans-sphenoidal surgery	-	-	32 (45.1%)
Indications for trans-sphenoidal surgery
Visual compromise	-	-	24 (75%)
Treatment failure	-	-	2 (6.3%)
ACTH-secreting	-	-	1 (3.1)
GH-secreting	-	-	1 (3.1%)
Not determined	-	-	4 (12.5%)
Trans-cranial surgery	-	-	39 (54.9%)
Indications for transcranial surgery
Visual compromise	-	-	33 (84.6%)
Tumor recurrence	-	-	4 (10.3)
Others	-	-	2 (5.1%)
Final histopathology report	-	-
Pituitary adenoma	-	-	67 (94.3%)
Pituitary adenoma with hemorrhage	-	-	4 (5.6%)

Table 1. Hormonal and Neuroradiological Evaluation and Surgical Management of Patients With Pituitary Adenoma

Characteristics of patients

Mean

f(%)

Hormonal evaluation

Level of ACTH (pg/mL)

95.80

113.43

2 (2.8%)

Level of cortisol (nmol/L)

450.46

1,222.89

55 (77.5%)

Level of LH (mIU/mL)

6.62

9.54

4 (5.6%)

Level of FSH (mIU/mL)

10.45

17.25

6 (8.5%)

Level of TSH (µIU/mL)

1.25

0.94

46 (64.8%)

Level of free T4 (pmol/L)

12.61

5.25

40 (56.3%)

Level of T4 (nmol/L)

79.09

31.51

14 (19.7%)

Level of free T3 (pmol/L)

3.32

1.18

10 (14.1%)

Level of T3 (nmol/L)

1.62

0.82

8 (11.3%)

Level of prolactin (mIU/L)

6,606.22

24,043.57

41 (57.7%)

Level of growth hormone (ng/mL)

15.35

21.56

2 (2.8%)

Level of testosterone (ng/mL)

1.55

1.40

4 (5.6%)

Level of estradiol (pg/mL)

19.13

9.48

2 (2.8%)

Neuroradiological evaluation

Size of the tumor

67 (94.4%)

Length

2.31

0.89

Width

2.44

0.95

Height

2.66

1.30

Tumor invasion

Hardy grading classification

Non-invasive (GRADE 0A-2E)

33 (46.5%)

Invasive (GRADE 3A-4E)

35 (49.3%)

Unspecified

3 (4.2%)

KNOSP grading classification

Non-invasive (GRADE 0-2)

43 (60.6%)

Invasive (GRADE 3-4)

25 (35.2%)

Unspecified

3 (4.2%)

Surgical management

Trans-sphenoidal surgery

32 (45.1%)

Indications for trans-sphenoidal surgery

Visual compromise

24 (75%)

Treatment failure

2 (6.3%)

ACTH-secreting

1 (3.1)

GH-secreting

1 (3.1%)

Not determined

4 (12.5%)

Trans-cranial surgery

39 (54.9%)

Indications for transcranial surgery

Visual compromise

33 (84.6%)

Tumor recurrence

4 (10.3)

Others

2 (5.1%)

Final histopathology report

Pituitary adenoma

67 (94.3%)

Pituitary adenoma with hemorrhage

4 (5.6%)

**Table 2.** Immediate Postoperative Complications
Complications	Transcranial (n = 39)	TSS (n = 32)	All (n = 71)	P-value
No. of patients with any complication	12 (30.7%)	11 (34.4%)	23 (32.4%)	0.747
Identified complications
Diabetes insipidus	10 (25.6%)	6 (18.8%)	16 (22.5%)	0.344
Transient	6 (15.4%)	6 (18.8%)	12 (16.9%)
Undetermined (until discharge)	4 (10.3%)	0 (0%)	4 (5.6%)
Transient CSF leak	2 (5.1%)	3 (9.4%)	5 (7%)	0.405
Hemorrhage	4 (10.3%)	2 (6.3%)	6 (8.5%)	0.436
Subarachnoid	2 (5.1%)	2 (6.3%)	4 (5.6%)
Subdural	1 (2.6%)		1 (1.4%)
Focal	1 (2.6%)		1 (1.4%)
Worsening of vision	1 (2.6%)	1 (3.1%)	2 (2.8%)	0.887
Headache	1 (2.6%)	1 (3.1%)	2 (2.8%)	0.887
Obstructive hydrocephalus	2 (5.1%)	0 (0%)	2 (2.8%)	0.194
Seizure	2 (5.1%)	0 (0%)	2 (2.8%)	0.194
Hospital-acquired pneumonia	1 (2.6%)	0 (0%)	1 (1.4%)	0.194
Death	1 (2.6%)	1 (3.1%)	2 (2.8%)	0.702

Table 2. Immediate Postoperative Complications

Complications

Transcranial (n = 39)

TSS (n = 32)

All (n = 71)

P-value

No. of patients with any complication

12 (30.7%)

11 (34.4%)

23 (32.4%)

0.747

Identified complications

Diabetes insipidus

10 (25.6%)

6 (18.8%)

16 (22.5%)

0.344

Transient

6 (15.4%)

6 (18.8%)

12 (16.9%)

Undetermined (until discharge)

4 (10.3%)

0 (0%)

4 (5.6%)

Transient CSF leak

2 (5.1%)

3 (9.4%)

5 (7%)

0.405

Hemorrhage

4 (10.3%)

2 (6.3%)

6 (8.5%)

0.436

Subarachnoid

2 (5.1%)

2 (6.3%)

4 (5.6%)

Subdural

1 (2.6%)

1 (1.4%)

Focal

1 (2.6%)

1 (1.4%)

Worsening of vision

1 (2.6%)

1 (3.1%)

2 (2.8%)

0.887

Headache

1 (2.6%)

1 (3.1%)

2 (2.8%)

0.887

Obstructive hydrocephalus

2 (5.1%)

0 (0%)

2 (2.8%)

0.194

Seizure

2 (5.1%)

0 (0%)

2 (2.8%)

0.194

Hospital-acquired pneumonia

1 (2.6%)

0 (0%)

1 (1.4%)

0.194

Death

1 (2.6%)

1 (3.1%)

2 (2.8%)

0.702

**Table 3.** Univariate Test Between Patient’s Clinical Profile and the Presence of Complications
Variables	No complications (n = 48)	With complications (n = 23)	P-value
Demographics
Age years	43 (100%)	44.09 (14.36)	28 (100%)	42.82 (14.17)	0.715
Elderly ≥ 60 years old	6 (12.5%)		2 (7.1%)		0.635
Sex		-		-	0.399
Females	26 (54.2%)		10 (35.7%)
Males	22 (45.8%)		13 (46.4%)
Presence of co-morbidities	20 (41.7%)	-	9 (32.1%)	-	0.839
With previous pituitary surgery	3 (6.3%)	-	2 (8.7%)	-	0.706
Clinical presentation
Presence of headache	22 (45.8%)		18 (78.3%)		0.009
Visual disturbances	37 (77.1%)		20 (86.9%)		0.3278
Nausea and vomiting	2 (4.2%)		3 (13%)		0.1713
Signs and symptoms of hypogonadism	4 (8.3%)		3 (13%)		0.533
Other signs and symptoms	8 (1.7%)		1 (4.3%)		0.1443
Microadenoma	5 (10.4%)		0 (0%)		0.108
Giant adenoma	10 (20.8%)		4 (17.4)		0.733
Hypopituitarism	22 (45.8)		9 (39.1)		0.594
Hormonal evaluation
Level of cortisol	35 (81.4%)	335 (543.86)	20 (71.4%)	651.95 (1,911.49)	0.360
Level of TSH	30 (69.8%)	1.23 (1.04)	16 (57.1%)	1.27 (0.72)	0.888
Level of prolactin	23 (53.5%)	4,760 (16,891)	18 (64.3%)	8,965.3 (31,312.8)	0.585
Neuroradiological evaluation
Size of the tumor
Length	48 (100%)	2.28 (0.98)	19 (82.6%)	2.36 (0.75)	0.734
Width	48 (100%)	2.3 (0.94)	19 (82.6%)	2.64 (0.96)	0.151
Height	48 (100%)	2.68 (1.43)	18 (82.6%)	2.63 (1.1)	0.881
Tumor invasion
Invasive Hardy grade
Invasive (n = 35)	24 (50%)	-	11 (47.8%)	-	0.8639
Invasive Knosp grade
Invasive (n = 25)	18 (31.3%)	-	7 (30.4%)	-	0.5597
Surgical management
Trans-sphenoidal surgery	21 (43.8%)	-	12 (52.2%)	-	0.405
Transcranial surgery	27 (56.3%)	-	11 (47.8%)	-	0.086

Table 3. Univariate Test Between Patient’s Clinical Profile and the Presence of Complications

Variables

No complications (n = 48)

With complications (n = 23)

P-value

N (%)

Mean (SD)

N (%)

Mean (SD)

Demographics

Age years

43 (100%)

44.09 (14.36)

28 (100%)

42.82 (14.17)

0.715

Elderly ≥ 60 years old

6 (12.5%)

2 (7.1%)

0.635

Sex

0.399

Females

26 (54.2%)

10 (35.7%)

Males

22 (45.8%)

13 (46.4%)

Presence of co-morbidities

20 (41.7%)

9 (32.1%)

0.839

With previous pituitary surgery

3 (6.3%)

2 (8.7%)

0.706

Clinical presentation

Presence of headache

22 (45.8%)

18 (78.3%)

0.009

Visual disturbances

37 (77.1%)

20 (86.9%)

0.3278

Nausea and vomiting

2 (4.2%)

3 (13%)

0.1713

Signs and symptoms of hypogonadism

4 (8.3%)

3 (13%)

0.533

Other signs and symptoms

8 (1.7%)

1 (4.3%)

0.1443

Microadenoma

5 (10.4%)

0 (0%)

0.108

Giant adenoma

10 (20.8%)

4 (17.4)

0.733

Hypopituitarism

22 (45.8)

9 (39.1)

0.594

Hormonal evaluation

Level of cortisol

35 (81.4%)

335 (543.86)

20 (71.4%)

651.95 (1,911.49)

0.360

Level of TSH

30 (69.8%)

1.23 (1.04)

16 (57.1%)

1.27 (0.72)

0.888

Level of prolactin

23 (53.5%)

4,760 (16,891)

18 (64.3%)

8,965.3 (31,312.8)

0.585

Neuroradiological evaluation

Size of the tumor

Length

48 (100%)

2.28 (0.98)

19 (82.6%)

2.36 (0.75)

0.734

Width

48 (100%)

2.3 (0.94)

19 (82.6%)

2.64 (0.96)

0.151

Height

48 (100%)

2.68 (1.43)

18 (82.6%)

2.63 (1.1)

0.881

Tumor invasion

Invasive Hardy grade

Invasive (n = 35)

24 (50%)

11 (47.8%)

0.8639

Invasive Knosp grade

Invasive (n = 25)

18 (31.3%)

7 (30.4%)

0.5597

Surgical management

Trans-sphenoidal surgery

21 (43.8%)

12 (52.2%)

0.405

Transcranial surgery

27 (56.3%)

11 (47.8%)

0.086

**Table 4.** Multivariate Analysis on Postoperative Complications
Variables in the equation	B	SE	P-value	OR	95% CI
Age	-0.002	0.022	0.929	0.998	0.956	1.042
Sex, males	0.737	0.618	0.233	2.091	0.622	7.026
Headache	0.629	0.587	0.284	1.875	0.594	5.924
Visual disturbance	-0.906	0.938	0.334	0.404	0.064	2.539
Signs and symptoms of hypogonadism	-0.315	1.022	0.758	0.73	0.098	5.41
Size of tumor length	-0.316	0.53	0.551	0.729	0.258	2.06
Size of tumor width	1.601	0.675	0.018	4.959	1.32	18.624
Size of tumor height	-0.9	0.492	0.067	0.407	0.155	1.066
Trans-sphenoidal surgery	0.187	0.658	0.776	1.206	0.332	4.381
Constant	-0.978	1.45	0.500	0.376

Table 4. Multivariate Analysis on Postoperative Complications

Variables in the equation

P-value

95% CI

Lower

Upper

Age

-0.002

0.022

0.929

0.998

0.956

1.042

Sex, males

0.737

0.618

0.233

2.091

0.622

7.026

Headache

0.629

0.587

0.284

1.875

0.594

5.924

Visual disturbance

-0.906

0.938

0.334

0.404

0.064

2.539

Signs and symptoms of hypogonadism

-0.315

1.022

0.758

0.73

0.098

5.41

Size of tumor length

-0.316

0.53

0.551

0.729

0.258

2.06

Size of tumor width

1.601

0.675

0.018

4.959

1.32

18.624

Size of tumor height

-0.9

0.492

0.067

0.407

0.155

1.066

Trans-sphenoidal surgery

0.187

0.658

0.776

1.206

0.332

4.381

Constant

-0.978

1.45

0.500

0.376