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The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism

BACKGROUND: Transsphenoidal hypophysectomy is one of the treatment strategies in the comprehensive management of dogs with pituitary‐dependent hypercortisolism (PDH). OBJECTIVES: To describe the influence of pituitary size at time of pituitary gland surgery on long‐term outcome. ANIMALS: Three‐hundr...

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Autores principales: van Rijn, S.J., Galac, S., Tryfonidou, M.A., Hesselink, J.W., Penning, L.C., Kooistra, H.S., Meij, B.P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108476/
https://www.ncbi.nlm.nih.gov/pubmed/27425149
http://dx.doi.org/10.1111/jvim.14367
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author van Rijn, S.J.
Galac, S.
Tryfonidou, M.A.
Hesselink, J.W.
Penning, L.C.
Kooistra, H.S.
Meij, B.P.
author_facet van Rijn, S.J.
Galac, S.
Tryfonidou, M.A.
Hesselink, J.W.
Penning, L.C.
Kooistra, H.S.
Meij, B.P.
author_sort van Rijn, S.J.
collection PubMed
description BACKGROUND: Transsphenoidal hypophysectomy is one of the treatment strategies in the comprehensive management of dogs with pituitary‐dependent hypercortisolism (PDH). OBJECTIVES: To describe the influence of pituitary size at time of pituitary gland surgery on long‐term outcome. ANIMALS: Three‐hundred–and‐six dogs with PDH. METHODS: Survival and disease‐free fractions were analyzed and related to pituitary size; dogs with and without recurrence were compared. RESULTS: Four weeks after surgery, 91% of dogs were alive and remission was confirmed in 92% of these dogs. The median survival time was 781 days, median disease‐free interval was 951 days. Over time, 27% of dogs developed recurrence of hypercortisolism after a median period of 555 days. Dogs with recurrence had significantly higher pituitary height/brain area (P/B) ratio and pre‐operative basal urinary corticoid‐to‐creatinine ratio (UCCR) than dogs without recurrence. Survival time and disease‐free interval of dogs with enlarged pituitary glands was significantly shorter than that of dogs with a non‐enlarged pituitary gland. Pituitary size at the time of surgery significantly increased over the 20‐year period. Although larger tumors have a less favorable prognosis, outcome in larger tumors improved over time. CONCLUSIONS AND CLINICAL IMPORTANCE: Transsphenoidal hypophysectomy is an effective treatment for PDH in dogs, with an acceptable long‐term outcome. Survival time and disease‐free fractions are correlated negatively with pituitary gland size, making the P/B ratio an important pre‐operative prognosticator. However, with increasing experience, and for large tumors, pituitary gland surgery remains an option to control the pituitary mass and hypercortisolism.
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spelling pubmed-51084762016-11-16 The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism van Rijn, S.J. Galac, S. Tryfonidou, M.A. Hesselink, J.W. Penning, L.C. Kooistra, H.S. Meij, B.P. J Vet Intern Med SMALL ANIMAL BACKGROUND: Transsphenoidal hypophysectomy is one of the treatment strategies in the comprehensive management of dogs with pituitary‐dependent hypercortisolism (PDH). OBJECTIVES: To describe the influence of pituitary size at time of pituitary gland surgery on long‐term outcome. ANIMALS: Three‐hundred–and‐six dogs with PDH. METHODS: Survival and disease‐free fractions were analyzed and related to pituitary size; dogs with and without recurrence were compared. RESULTS: Four weeks after surgery, 91% of dogs were alive and remission was confirmed in 92% of these dogs. The median survival time was 781 days, median disease‐free interval was 951 days. Over time, 27% of dogs developed recurrence of hypercortisolism after a median period of 555 days. Dogs with recurrence had significantly higher pituitary height/brain area (P/B) ratio and pre‐operative basal urinary corticoid‐to‐creatinine ratio (UCCR) than dogs without recurrence. Survival time and disease‐free interval of dogs with enlarged pituitary glands was significantly shorter than that of dogs with a non‐enlarged pituitary gland. Pituitary size at the time of surgery significantly increased over the 20‐year period. Although larger tumors have a less favorable prognosis, outcome in larger tumors improved over time. CONCLUSIONS AND CLINICAL IMPORTANCE: Transsphenoidal hypophysectomy is an effective treatment for PDH in dogs, with an acceptable long‐term outcome. Survival time and disease‐free fractions are correlated negatively with pituitary gland size, making the P/B ratio an important pre‐operative prognosticator. However, with increasing experience, and for large tumors, pituitary gland surgery remains an option to control the pituitary mass and hypercortisolism. John Wiley and Sons Inc. 2016-07-18 2016 /pmc/articles/PMC5108476/ /pubmed/27425149 http://dx.doi.org/10.1111/jvim.14367 Text en Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle SMALL ANIMAL
van Rijn, S.J.
Galac, S.
Tryfonidou, M.A.
Hesselink, J.W.
Penning, L.C.
Kooistra, H.S.
Meij, B.P.
The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism
title The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism
title_full The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism
title_fullStr The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism
title_full_unstemmed The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism
title_short The Influence of Pituitary Size on Outcome After Transsphenoidal Hypophysectomy in a Large Cohort of Dogs with Pituitary‐Dependent Hypercortisolism
title_sort influence of pituitary size on outcome after transsphenoidal hypophysectomy in a large cohort of dogs with pituitary‐dependent hypercortisolism
topic SMALL ANIMAL
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108476/
https://www.ncbi.nlm.nih.gov/pubmed/27425149
http://dx.doi.org/10.1111/jvim.14367
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