Starting point for benchmarking outcomes and reporting of pituitary adenoma surgery within the European Reference Network on Rare Endocrine Conditions (Endo-ERN): results from a meta-analysis and survey study

Amir H Zamanipoor Najafabadi*, Merel van der Meulen, MTG6 Pituitary of Endo-ERN, Ana Luisa Priego Zurita, S Faisal Ahmed, Wouter R van Furth, Evangelia Charmandari, Olaf Hiort, Alberto M Pereira, Mehul Dattani, Diana Vitali, Johan P de Graaf, Nienke R Biermasz

*Corresponding author for this work

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Abstract

Objective: The European Reference Network on Rare Endocrine Conditions (Endo-ERN)
aims to organize high-quality healthcare throughout Europe, including care for pituitary
adenoma patients. As surgery is the mainstay of treatment, we aimed to describe the
current surgical practice and published surgical outcomes of pituitary adenoma within
Endo-ERN.
Design and Methods: Systematic review and meta-analysis of studies reporting surgical
outcomes of pituitary adenoma patients within Endo-ERN MTG6 pituitary reference
centers between 2010 and 2019. A survey was completed by reference centers on their
current surgical practice.
Results: A total of 18 out of 43 (42%) reference centers located in 7 of the 20 (35%) MTG6-
represented countries published 48 articles. Remission rates were 50% (95% CI: 42–59)
for patients with acromegaly, 68% (95% CI: 60–75) for Cushing’s disease, and 53% (95%
CI: 39–66%) for prolactinoma. Gross total resection was achieved in 49% (95% CI: 37–61%) of patients and visual improvement in 78% (95% CI: 68–87). Mortality, hemorrhage, and
carotid injury occurred in less than 1% of patients. New-onset hypopituitarism occurred
in 16% (95% CI: 11–23), transient diabetes insipidus in 12% (95% CI: 6–21), permanent
diabetes insipidus in 4% (95% CI: 3–6), syndrome of inappropriate secretion of
antidiuretic hormone (SIADH) in 9% (95% CI: 5–14), severe epistaxis in 2% (95% CI: 0–4),
and cerebrospinal fluid leak in 4% (95% CI: 2–6). Thirty-five (81%) centers completed the
survey: 54% were operated endoscopically and 57% were together with an ENT surgeon.
Conclusion: The results of this study could be used as a first benchmark for the outcomes
of pituitary adenoma surgery within Endo-ERN. However, the heterogeneity between
studies in the reporting of outcomes hampers comparability and warrants outcome
collection through registries.
Original languageEnglish
Article numbere220349
Number of pages12
JournalEndocrine Connections
Volume12
Issue number1
Early online date13 Dec 2022
DOIs
Publication statusPublished - Jan 2023

Bibliographical note

Funding Information:
This publication has been supported by Endo-ERN, which is co-funded by the European Union’s third Health Programme (CHAFEA Framework Partnership Agreement No 739527).

Publisher Copyright:
© 2022 The authors.

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