Evaluation of treatment outcomes and postoperative complications
tumor, diabetes insipidus, adenoma
TUMOR, RESIDUAL TUMOR, DIABETES INSIPIDUS, REMISSION, SYNDROME, SYNDROMES, CONCOMITANT DISEASE, ADENOMA, COMPLICATIONS
The study of the level of basal GH was carried out on the 1st day after the operation. GH level <2 ng/mL may be a predictor of long-term remission, but the value of this test is limited due to the possible increase in the level of GH as a result of excessive production by normal pituitary somatotrophs as a result of surgical stress on the organism. After surgery for 2 weeks, monitoring of electrolyte levels, symptoms of diabetes insipidus and syndrome of inappropriate secretion of antidiuretic hormone, monitoring of adrenal function was performed. The results of surgical treatment were evaluated 12 weeks after the operation. The tumor removal radicality was evaluated based on the operating surgeon’s subjective opinion, clinical data, postoperative hormonal findings, and postoperative MRI data or CT data in the presence of contraindications to stay in a magnetic field. Total tumor removal refers to the surgical outcome where residual tumor is found neither according to the surgeon’s opinion nor according to the postoperative CT and MRI data. In the subtotal tumor removal, the residual tumor volume did not exceed 20% of the original tumor. The postoperative CT and MRI analysis provided no evidence of residual tumor. At the same time, evidence of the blood hormone level returning to normal was absent. Those cases were classified as subtotal resection. The tumor removal was classified as partial when less than 80% of the original adenoma was excised. The evaluation of the MRI and CT scans was performed by two independent radiologists unfamiliar with the study design.The level of IGF-1 and GH was studied during an oral glucose tolerance test (75 g of glucose per os with a study of the level of GH every 30 minutes for 2 hours). If the level of IGF-1 in the blood decreased but did not reach the norm, the level of IGF-1 was re-examined after 9–12 weeks due to the possible delayed normalization of its level in some patients.Treatment effectiveness was evaluated by analyzing the dynamics of the primary syndromes: endocrine, visual, and neurological. The complications were classified as mild, moderate, and severe. Mild complications refer to the new symptoms emergence associated with the underlying or concomitant disease, which slightly worsens the patient’s condition and ability to work. Nevertheless, the impact on health and working ability is not critical though. Moderate complications make patients unable to work but they can still take care of themselves. Severe complications imply that a patient loses their ability to work and self-care. In this case, they require outside help.