ORIGINAL
Introdução: Avaliar o perfil epidemiológico, radiológico, imuno-histoquímico e os desfechos cirúrgicos dos adenomas gigantes de hipófise tratados no Hospital Cristo Redentor. Métodos: Estudo de coorte retrospectivo realizado por meio da revisão de prontuários entre agosto de 2011 e dezembro de 2022. Foram incluídos na análise pacientes com adenomas gigantes de hipófise operados no Hospital Cristo Redentor durante o período analisado. O objetivo principal foi analisar o perfil epidemiológico da população. Os objetivos secundários foram a análise imuno-histoquímica, as características radiológicas e os resultados cirúrgicos. Resultados: Dezoito pacientes foram selecionados. O tamanho médio das lesões foi de 47 mm. Todos apresentaram sintomas visuais e algum distúrbio de secreção hormonal. A ressecção completa foi possível em 16% dos casos, e 67% apresentaram melhora visual. Abordagens cirúrgicas múltiplas foram necessárias em 44% dos pacientes. Não foram observadas associações estatísticas entre a análise imuno-histoquímica e os desfechos cirúrgicos, grau de invasão de estruturas adjacentes ou necessidade de múltiplas abordagens. Conclusão: O estudo evidencia a dificuldade de comparação entre as séries da literatura, dada a heterogeneidade nos critérios para definição de adenomas gigantes e de ressecção completa. A alta taxa de tumores invasivos e os padrões complexos de crescimento exigiram, com frequência, abordagens cirúrgicas combinadas. A radioterapia teve papel importante como tratamento adjuvante nos casos de controle cirúrgico insuficiente. Os resultados são semelhantes aos encontrados na literatura e refletem a complexidade do tratamento dessa patologia.
Introduction: Evaluate the epidemiological, radiological, and immunohistochemical profile and surgical outcomes of giant pituitary adenomas treated at the Cristo Redentor hospital. Methods: A retrospective cohort study was conducted by reviewing medical records from August 2011 to December 2022. Patients with giant pituitary adenomas operated on at the Cristo Redentor hospital during the analyzed period were included in the analysis. The primary objective was to analyze the epidemiological profile of the population. The secondary objectives were immunohistochemical analysis, radiological characteristics, and surgical results. Results: Eighteen patients were selected. The average lesion size was 47 mm. All presented visual symptoms and some hormone secretion disorder. Complete resection was possible in 16%, and 67% obtained visual improvement. Multiple surgical approaches were required in 44% of patients. No statistical associations were observed between immunohistochemical analysis and surgical outcomes, degree of invasion of adjacent structures, or multiple approaches. Conclusion:: This study highlights the limited comparability between series due to heterogeneous definitions of giant adenomas and resection criteria. The high rate of invasive tumors and complex growth patterns often required combined surgical approaches. Radiotherapy played a key role in adjuvant treatment when surgical control was insufficient. The results are similar to those found in the literature and reflect the complexity of treating this pathology.
1. Makarenko S, Alzahrani I, Karsy M, Deopujari C, Couldwell WT. Outcomes and surgical nuances in management of giant pituitary adenomas: a review of 108 cases in the endoscopic era. J Neurosurg. 2022;137(3):635-46. http://doi.org/10.3171/2021.10.JNS21659. PMid:35061979.
2. Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: histological types, clinical features and therapeutic approaches. Endocrine. 2018;61(3):407-21. http://doi.org/10.1007/s12020-0181645-x. PMid:29909598.
3. Gaillard S, Adeniran S, Villa C, et al. Outcome of giant pituitary tumors requiring surgery. Front Endocrinol. 2022;13:975560. http:// doi.org/10.3389/fendo.2022.975560. PMid:36105410.
4. Scheithauer BW, Kovacs KT, Laws ER Jr, Randall RV. Pathology of invasive pituitary tumors with special reference to functional classification. J Neurosurg. 1986;65(6):733-44. http://doi.org/10.3171/ jns.1986.65.6.0733. PMid:3095506.
5. Trott G, Ongaratti BR, De Oliveira Silva CB, et al. PTTG overexpression in non-functioning pituitary adenomas: correlation with invasiveness, female gender and younger age. Ann Diagn Pathol. 2019;41:83-9. http://doi.org/10.1016/j.anndiagpath.2019.04.016. PMid:31154064.
6. Liu X, Feng M, Zhang Y, et al. Expression of matrix metalloproteinase-9, pituitary tumor transforming gene, high mobility group A 2, and Ki-67 in adrenocorticotropic hormone–secreting pituitary tumors and their association with tumor recurrence. World Neurosurg. 2018;113:e21321. http://doi.org/10.1016/j.wneu.2018.01.214. PMid:29432944.
7. Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33(4):610-8. http://doi.org/10.1227/00006123-199310000-00008. PMid:8232800.
8. Rahimli T, Hidayetov T, Yusifli Z, Memmedzade H, Rajabov T, Aghayev K. Endoscopic endonasal approach to giant pituitary adenomas: surgical outcomes and review of the literature. World Neurosurg. 2021;149:e104355. http://doi.org/10.1016/j.wneu.2021.01.019. PMid:33524611.
9. Gondim JA, Almeida JPC, Albuquerque LAF, Gomes EF, Schops M. Giant pituitary adenomas: surgical outcomes of 50 cases operated on by the endonasal endoscopic approach. World Neurosurg. 2014;82(12):e281-90. http://doi.org/10.1016/j.wneu.2013.08.028. PMid:23994073.
10. Mortini P, Barzaghi R, Losa M, Boari N, Giovanelli M. Surgical treatment of giant pituitary adenomas: strategies and results in a series patients. World Neurosurg. 2015;84(4):978-88. http://doi.org/10.1016/j. wneu.2015.06.007. PMid:26074433.
12. Gaia F, Gonzalez-Reyes L, Belfort MA, Medeiros RGB, Bendinid JD, Barbosa GF. Analyzing giant pituitary adenomas: an 8-year review (2012–2020) at a reference center in Brazil. Clin Neurol Neurosurg. 2022;213:107138. http://doi.org/10.1016/j.clineuro.2022.107138. PMid:35066248.
13. Buchfelder M, Kreutzer J. Transcranial surgery for pituitary adenomas. Pituitary. 2008;11(4):375-84. http://doi.org/10.1007/s11102-008-01208. PMid:18421581.
14. Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Paluzzi A, Wang EW, Snyderman CH. Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations. J Neurosurg. 2013;118(3):621-31. http://doi.org/10.3171/2012.11.JNS121190. PMid:23289816.
15. Youssef AS, Agazzi S, Van Loveren HR. Transcranial surgery for pituitary adenomas. Neurosurgery. 2005;57(1, Suppl 1):168-75. http:// doi.org/10.1227/01.NEU.0000163602.05663.86. PMid:15987585.
16. Luzzi S, Giotta Lucifero A, Rabski J, Kadri PAS, Al-Mefty O. The party wall: redefining the indications of transcranial approaches for giant pituitary adenomas in endoscopic era. Cancers. 2023;15(8):2235. http://doi.org/10.3390/cancers15082235. PMid:37190164.
17. Alleyne CH Jr, Barrow DL, Oyesiku NM. Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol. 2002;57(6):380-90, discussion 390. http://doi.org/10.1016/ S0090-3019(02)00705-X. PMid:12176196.
1Neurosurgery Department, Hospital Cristo Redentor, Porto Alegre, RS, Brazil.
2Pathology Department, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
3School of Medicine, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil.
Received Apr 6, 2025
Corrected Apr 22, 2025
Accepted Apr 28, 2025
