Muhammad Shahzad Shamim, Faraz Khursheed, Muhammad Ehsan Bari.
Operating on the master gland: 100 consecutive Hypophysectomies at Aga Khan University Hospital, Karachi.
Pak J Neurological Sci Jan ;1(2):66-9.

Objective: To review the epidemiology and surgical outcomes of patients presenting with pituitary adenomas. Materials and Methods: Hospital charts were retrieved using the ICD9-Clinical Modifications system, and data recorded on a structured form. A total of 100 consecutive patients undergoing surgery at our hospital for sellar masses from 1998 to 2004, and with final histopathological diagnosis of pituitary adenoma, were selected. Information was collected on multiple variables and standard statistical analyses were performed. Results: Of 100 patients, 65 were male and 35 female. Mean age was 38 + 16 years (range 1-76 years). Commonest symptoms were headache and visual disturbance (seen in 60%): twenty four patients presented with features of acromegaly. Mean duration of symptoms (excluding apoplexy), was 16 months (range 1 month-18 years). Ten patients had pituitary apoplexy. Hormone studies were available for 90 patients; (46% functioning adenomas, 54% non-functioning; 53% macro-adenomas, 47% micro-adenomas); commonest elevated hormone was growth hormone. Males were more likely to have macro-adenomas and non-functioning adenomas. Mean pituitary adenoma size was 26.74 ± 16 mm (range 3-78 mm). Commonest surgical approach was trans-nasal trans-sphenoidal (88%). Mean follow-up was 17.34 months (clinical) and 8.79 months (radiological). Post-operative radiotherapy was administered to 14 patients, nine of whom were re-operated for residual tumor. Conclusion: Surgical management of pituitary tumors in Pakistan is satisfactory and comparable with the international literature. In contrast with Western series, our patients are more likely to present either with a giant pituitary adenoma or with apoplexy.

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