Hipopituitarizem in diabetes insipidus po operacijah makroadenomov hipofiz s fluorescenčnim barvilom

Felbabić, Tomislav (avtor), Velnar, Tomaž (mentor), Kocjan, Tomaž (komentor)

Ozadje: Adenomi hipofize so benigni tumorji, ki predstavljajo približno 18% vseh intrakranialnih tumorjev. So tretji najpogostejši intrakranialni tumorji, ki zahtevajo kirurški poseg. Med operacijo je pomembno razlikovati hipofizno tkivo od adenoma. Tako lahko tumor varno odstranimo z malo tveganja za zaplete zaradi poškodbe hipofize. V naši raziskavi smo predpostavili, da bo zaradi uporabe ICG barvila incidenca zapletov manjša. Metode: Prospektivna randomizirana raziskava je potekala med februarjem 2019 in oktobrom 2023. Vključili smo 34 bolnikov z nefunkcionalnim makroadenomom hipofize. Naključno so bili razporejeni v skupino, ki je intraoperativno prejela ICG, in kontrolno skupino. Vsi bolniki so bili operirani z endoskopsko-endonazalno-transfenoidnim pristopom. Predoperativno, takoj po operaciji in 3-6 mesecev po operaciji smo pri bolnikih ocenili delovanje adenohipofize in nevrohipofize. Funkcijo adenohipofize smo ocenjevali z rutinskimi hormonskimi preiskavami: hitri ACTH test z določanjem kortizola bazalno in po 30 minutah, TSH, pT3, pT4, prolaktin, FSH, LH, IGF-1, pri moških še testosteron. Funkcijo nevrohipofize smo ocenili z merjenjem tekočinskega ravnovesja, osmolalnosti prvega jutranjega urina in serumskega natrija. Pred operacijo in 3-6 mesecev po operaciji so vsi bolniki opravili MR slikanje glave po protokolu za hipofizo. Rezultati: Od 34 bolnikov je bilo 23 moških (67,7%) in 11 žensk (23,3%), starih med 33 in 81 let, povprečno 60,9 let. V ICG skupini je medoperativno likvorejo imelo 29,4% in pooperativno 23,5% bolnikov, kontrolni skupini medoperativno 23,5% in pooperativno 17,6% . Pooperativno je 5,9% bolnikov iz ICG skupine imelo diabetes insipidus in 23,5% iz kontrolne skupine. Funkcija adenohipofize se je pooperativno poslabšala pri 52,9% bolnikih ICG in pri 35,3% bolnikih kontrolne skupine. Glede na pooperativni MR glave je bila popolna odstranitev makroadenoma pri 88,2% bolnikih ICG in 82,4% bolnikih kontrolne skupine. Zaključki: Na podlagi naše raziskave ne moremo potrditi prednosti uporabe ICG pri endoskopskih endonazalnih transsfenoidnih operacijah nefunkcionalnih makroadenomov hipofize. Potrebne so dodatne raziskave z večjim vzorcem bolnikov.

• Jezik: Slovenski jezik
• Ključne besede: hipofiza, adenohipofiza, nevrohipofiza, nefunkcionalni makroadenomi, ICG barvilo, endoskopska endonazalna kirurgija, diabetes insipidus, hipofizno-periferna os
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2025
• PID: 20.500.12556/RUL-168587
• Datum objave v RUL: 18.04.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Hypopituitarism and diabetes insipidus after pituitary macroadenoma surgery with fluorescent dye

Izvleček

Background: Pituitary adenomas are benign tumors accounting for about 18% of all intracranial tumors. They are the third most common intracranial tumor needing surgical intervention. Differentiating pituitary tissue from the adenoma during surgery is crucial to safely remove the tumor with minimal risk of complications from pituitary damage. We hypothesized that using ICG dye intraoperatively would reduce complication rates. Methods: This prospective randomized study was conducted from February 2019 to October 2023, involving 34 patients with non-functional pituitary macroadenomas. Patients were randomly assigned to receive ICG intraoperatively or to a control group. All surgeries used an endoscopic endonasal transsphenoidal approach. Adenohypophysis and neurohypophysis functions were assessed preoperatively, immediately postoperatively, and 3-6 months postoperatively using hormonal tests. Preoperative and postoperative MRIs were conducted according to a pituitary protocol. Results: Of the 34 patients, 23 were male (67.7%) and 11 female (32.3%), aged 33 to 81 years, with an average age of 60.9 years. Intraoperative cerebrospinal fluid leaks occurred in 29.4% of the ICG group and 23.5% of the control group, while postoperative leaks were 23.5% and 17.6%, respectively. Diabetes insipidus occurred postoperatively in 5.9% of the ICG group and 23.5% of the control group. Adenohypophysis function worsened postoperatively in 52.9% of the ICG group and 35.3% of the control group. Complete removal of the macroadenoma was achieved in 88.2% of the ICG group and 82.4% of the control group based on postoperative MRI. Conclusions: Our study does not confirm the advantages of using ICG in endoscopic endonasal transsphenoidal surgeries for non-functional pituitary macroadenomas. Further research with a larger patient sample is necessary.

• Ključne besede: pituitary, adenohypophysis, neurohypophysis, non-functioning macroadenomas, ICG dye, endoscopic endonasal surgery, diabetes insipidus, pituitary–peripheral axis