MMed (Neurological Surgery), Faculty of Health Sciences, University of the Witwatersrand / The purpose of this retrospective study was to review the patient records with regard to demographics, clinical presentation, laboratory tests, histology, management and outcome of patients presenting at Chris Hani Baragwanath and Charlotte Maxeke Johannesburg Academic Hospitals with pituitary adenomas over a ten year period from 1999 to 2008. Methods: The patient records accessed included discharge summaries, admission files, laboratory results, imaging films, ophthalmology records and histology results. The information gathered was analyzed in terms of the above mentioned parameters. Results: There was a slight female preponderance at 55% vs 45% males, with a mean age of 46 years. 89% of the study population was of a Black race, reflecting the actual demographic pattern of the hospital population rather than the tumour prevalence in Blacks. Visual disturbance (94%) and headaches (75%) were very common and reflected the late presentation of our patients. Features of hypopituitarism and hyperprolactinaemia were the commonest of hormone imbalances at 33% and 39% respectively. 80% of the total study population was treated by transphenoidal surgery. The remainder was mainly prolactinomas treated with oral dopamine agonists and those who refused surgery. 2% required transcranial approach while 13% received further radiation therapy. Outcome was good with regard to improvement or resolution of headaches at 65%, while improvement in visual acuity and field defects were less satisfactory, with 51% showing improvement, and 44% remaining the same post operatively. This underlies the concern regarding late presentation of our patients with irreversible visual impairment.
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100% of prolactinomas showed improvement or normalization of the prolactin levels with bromocriptine or carbegoline, however, of those who presented with hypopituitarism 43% required post operative hormone replacement in the form of cortisol acetate or prednisone and thyroxin. Conclusion: Our patient demographics are similar to those published elsewhere, however, of great concern is the late presentation with irreversible visual impairment and hormonal imbalance. Government and community education, in a multidisciplinary approach is required to improve our situation.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/8798 |
| Date | 27 September 2010 |
| Creators | Matshana, Kennedy John |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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