During the three years in the pandemic, 119 patients were registered, of which 64 are male (53.8%) and 55 are female (46.2%), age range is 14 to 85 years with a mean of 52.10 years (Figure 1., 2.).
Macroadenoma was recorded in 95 patients (79.83%), microadenoma in 22 patients (18.49%), and giant adenoma in 2 patients (1.69%) (Figure 3.). The most frequent histopathological finding is gonadotrophic adenoma with a frequency of 78.99% (94 patients). It is followed by corticothropic adenoma with a frequency of 16.80% (20 patients), somatotropic adenoma with a frequency of 3.36% (4 patients), and prolactinoform adenoma with a frequency of 0.84% (1 patient). The Ki67 index was diveded into categories 0-0.5 in 110 patients (92.44%); 0.6-1.0 in 7 patients (5.89%), 1–5 in 2 patients (1.68%). The mitotic index was divided into categories: one mitosis per 10 fileds of high magnification in 87 patients (73.11%), ten mitoses in 10 high magnification fields in 2 patients (1.68%), and rare mitoses in 30 patients (25.21%).
The most common symptom was visual impairment recorded in 52 patients (43.7%) in the form of diopter disturbance (38 patients), vision loss in one eye (10 patients), and blurred vision (4 patients). Hemianopsia was recorded in 31 patient (26.05%), and ptosis was recorded in 8 patients (6.72%). Abducens nerve paresis was recorded in 12 patients (10.08%).
Acromegaly was recorded in 5 patients (4.2%), hyperthyroidism in 8 patients (6.72%), hypothyroidism in 4 patients (3.37%), Cushing’s syndrome in 17 patients (14.29%), while 61 patient (51.27%) complained of fatigue, weakness, and forgetfulness. Headache was recorded in 94 patients (79%). A menstrual cycle disorder was also recorded in 5 women (4.2%). In men, prostate hyperplasia was noted in 6 patients (5.04%). Rheumatoid arthritis was noted in 16 patients (13.45%), and cholecystectomy was recorded in 16 patients (14.45%) as well.
The size of the pituitary adenoma was also expressed through the volume in cm3. Maximum adenoma volume was 35cc, minimum volume was 0.007cc (mean volume 25,33cc). Complete resection of pituitary adenoma was performed in 109 patients (91.60%), and partial in 10 patients (8.40%). Plastic base was performed in 12 patients (10.08%) with fat tissue or muscle fascia.
Postoperative complications in the early posoperative period were recorded in 48 patients (40.34%), while in 71 (59.66%) patient it was not recorded. Deep vein thrombosis and pulmonary embolism was recorded in 1 patient (0.84%). Epistaxis occurred in 8 patients (6.72%). Rhinoliquorrhea occurred in 11 patients (9.24%). Meningitis as a complication occured in 2 patients (1.68%). Pneumocephalus was recorded in 13 patients (10.92%).
Hematoma appeared in 1 patient (0.84%). Visual impairment occurred in 1 patient as well (0.84%). Death was recorded in 2 patients (1.68%) during the COVID-19 pandemic period; one patient died caues of meningitis complications, and the other patient died due postraumatic brain injury complications caused by subdural hematoma and brain contusion.
Transient DI developed postoperatively in 11 patients (9.24%), where 7 were female, and 4 were male. We have divided the transient DI into three categories: up to 5 litres diuresis which was recorded in 2 patients (1.68%), from 5 to 10 litres diuresis which was recorded in 9 patients (7.56%), and over 10 litres diuresis which was not recorded at all. In the event of hypernatremia minirin was applied.
Along with diuresis, we monitored serum sodium levels and urine osmolality. As previously stated, sodium is normally found in the serum in a concentration of 135-145 mmol/l. The minimum recorded value sodium is 135mmol/l and the maximum was 200 mmol/l. The average sodium values were 144.19±5 mmol/l. In 78 patients (65.55%) the urine osmolality is less than 300 mOsm/kg and in 55 of patients (46.21%) was greater than 300 mOsm/kg.
The influence of age on the occurrence of transient DI was examined and it is highly statistically significant difference in the frequency of occurrence of transient DI depending on the age of the patient - Pearson's χ2 test - p=0.05. Transient DI occurs most often between the ages 11 and 20 (0%), 21 and 30 (0%), 31 to 40 years (0%), 41 to 50 (2.52%), 51 to 60 (0.84%), 61 up to 70 (2.52%), over 70 (2.52%). Based on this, it can be concluded that transitory DI occurs in older patients.
The influence of the patient’s gender, the presence of visual impairment and the type of visual impairment was examined, then the existence of headaches and hormone level disorders, acromegaly, hyperthyroidism and hypothyroidism, Cushing's syndrome, size and duration of complaints on frequency of occurrence of transient DI. No statistically significant difference in frequency was obtained.
The influence of histopathological findings on the frequency of occurrence of transient DI was investigated and the statistically significant difference does not exists in the frequency of occurrence of transient DI depending on histopathology of findings - Pearson's χ2 test - p=0.904. Transient DI occurs most often in patients with gonadotrophic adenoma (7.56%), flowed by corticotropic adenoma (0.84%) and prolactinoma (0.84%). The influence of adenoma functionality on the frequency of occurrence of transient DI was investigated and no statistically significant difference exists in the frequency of occurrence of transient DI depending on the functionality adenoma.
We also made an analysis of how many patients suffered from COVID-19 before coming to the surgical treatment of pituitary adenoma. A total of 35 people (29.41%) tested positive for COVID-19. Of these, 21 are male (17.65%) and 14 are female (11.76%).
An analysis of the duration of hospitalization from the first to the last hospital day, as well as duration of hospitalization from the day the patient was operated on to the last hospital day was made as well. The minimum number of days spent in the hospital was 2 days, while the maximim was 72 day (average 7±4 days). Most often patients spended 4 days (31.93%), then 5 days (13.45%), 7 days (12.60%), 8 days (9.24%), then, in terms of duration, the stay in the hospital for a time period of 6 (5.88%) and 9 days followed equally (5.88%), then 10 days (5.04%).
An analysis of patients presenting to the Emergency Center with head injuries was also conducted. These patients were also diagnosed with a pituitary tumor. A total of 53 patients had a head injury (44.54%), of which 10 patients (8.40%) had a subdural hematoma, and 2 patients (1.68%) an epidural hematoma, while 11 patients (9.24%) had a brain contusion (9.24%), 7 patients (5.88%) had a skull fracture, 11 patients (9.24%) had a fracture of the facial mass, while the remaining 12 patients (10.08%) had a linear fracture without dislocation, and without indication for operative treatment.