Mortality and Morbidity after
Transsphenoidal Surgery for Pituitary Adenomas
by Brooke Swearingen, M.D. and Nicholas
T. Zervas, M.D.
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In order to investigate the problems
faced by patients with pituitary disease, we have reviewed the
long-term morbidity and mortality after transsphenoidal surgery
in 349 patients who underwent surgery at MGH between 1978 and
1985. Follow-up data were obtained by telephone interview and
written questionnaire, and cause of death confirmed by hospital
record, family contact, or death certificate. We were specifically
- the relative mortality rate
as compared with controls, and
- the overall morbidity as shown
by complications, disability and need for hormone replacement.
We have obtained follow-up on
299 of 349 patients (86 %) operated on between 1978-85. Of those
lost to follow-up, about 2/3 appear to be foreign nationals.
The average age at operation was 41, and mean follow-up was
The majority of tumors were either
nonfunctioning, includuing alpha secreting tumors, or prolactinornas
(recalling that bromocriptine was only coming into wide-spread
usage during this period).
Thirty nine deaths were documented
over the 13 year follow-up; average age at death was 72 years.
The primary cause of death was cardiovascular, at 27.5% followed
by non -pituitary neoplasm (20%) and pituitary-related deaths
(20%). When compared to the population at large (not age matched),
the primary cause of death was also cardiovascular (40%), followed
by neoplastic (at 24%).
Do patients with pituitary tumors
have a higher mortality rate than the population as a whole?
Using age matched historical controls, the expected mortality
over the period of follow-up calculated on a per patient per
year at risk basis is 44 deaths, as opposed to our actual 39.
The validity of this in part depends upon the assumption that
those patients lost to follow-up die at the same expected rate.
When calculating expected mortality
by tumor type we see that in our group only the Cushing's patients
died at a higher than expected rate; those with non-functioning
tumors actually lived slightly longer than expected
Mortality by Tumor Type
How did the pituitary related (total=8) deaths occur?
- one patient died of metastatic
- one died of meningitis after
a craniotomy elsewhere;
- four patients had giant macroadenomas
refractory to therapy; two patients had pituitary tumors listed
as the cause of death but no other information is available.
The perioperative mortality in this group was zero.
What were the major surgical complications?
- three cases of worsening vision
- two cases of meningitis
- two cases of CSF rhinorrhea
- one case of severe epistaxis
The requirement for long-term
homone replacement was clearly a function of whether the patient
received radiation treatment; 50% of radiated patients were
receiving replacement in at least one axis, while 10% of non-radiated
patients did so. The incidence of permanent diabetes insipidus
was 3%, in both groups.
Were the patients disabled by
surgery for their pituitary tumor? In general, the vast majonty
of patients returned to work, with only 4% disabled by their
Overall, then, with modern transsphenoidal
surgery and medical management, pituitary disease is well tolerated
over long periods of time. The surgery itself carries a low
morbidity and mortality, and most patients are able to continue
to lead productive lives
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