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S275: CHARACTERIZATION OF QUALITY-OF-LIFE OUTCOMES FOLLOWING ENDOSCOPIC TRANSSPHENOIDAL SURGERY, A MULTI-CENTER ANALYSIS
Vivienne Li, BA¹; Jack Olmstead, PhD¹; Thomas Beaumont, MD, PhD²; Adam DeConde, MD³; Carol Yan, MD³; ¹University of California San Diego School of Medicine, La Jolla, CA USA; ²Department of Neurosurgery, University of California San Diego, La Jolla, CA USA; ³Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, La Jolla, CA USA

Introduction: The endoscopic endonasal approach (EEA) is the preferred technique for resection of pituitary and sellar tumors. Beyond acute surgical complications, manipulation of the sinonasal corridor and pituitary gland may lead to persistent sinonasal inflammation, olfactory impairment, and endocrine dysfunction, all of which may significantly impact quality-of-life (QoL). This study leveraged a large multi-center electronic health record database to characterize the incidence and temporal patterns of sinonasal and endocrine sequelae following EEA.  

Methods: We conducted a retrospective cohort study using the Epic Cosmos database to identify patients who underwent EEA (CPT code: 62165) between January 2014 to January 2024. Patients with pre-existing hypopituitarism, adrenal insufficiency, sinusitis, olfactory loss, corticosteroid use, or hormone replacement were excluded from respective outcome analyses. Incidence of post-operative adrenal insufficiency, sinusitis, subsequent endoscopic sinus surgery (ESS), olfactory dysfunction, syndrome of inappropriate antidiuretic hormone release (SIADH), and pituitary-hormone replacement prescriptions (corticosteroid, thyroid, desmopressin, sex hormones, growth hormones) were assessed over defined postoperative intervals up to 24 months.  

Results: A total of 11,041 patients were identified. Within 24 months of EEA, 26.7% developed new-onset sinusitis, with the highest incidence in the first 2 months postoperatively (16.8%) (Figure 1). However, only 1.7% of the affected patients required ESS within 24 months. The 1-year incidence of post-operative olfactory dysfunction was 2.4%. New onset diagnosed endocrinopathies were most commonly diagnosed in the first 2 months post-operatively, with adrenal insufficiency and SIADH comprising 11.2% and 3.5% of the cohort, respectively, with incidence rates dropping down to 1.5% and 0.1% after 12 months (Figure 2). Hormone replacement was common and temporally distinct: hydrocortisone, thyroid hormone, desmopressin, and prednisone peaked in the early post-operative period (0-2 months; 44.1%, 27.5% 19.6%, and 5.1% respectively), whereas sex-hormone and growth-hormone replacement peaked later (3-6 months and 13-24 months periods, respectively) (Figure 3). The need for hormone replacement after 12 months ranged from 0.2% to 2.3%, with thyroid hormone being the most common, suggesting permanent endocrinopathy.  

Conclusion: This is the largest multi-institutional study to date demonstrating that EEA is associated with substantial post-operative sinonasal and endocrine morbidity, with distinct early and late temporal patterns. The findings highlight the need for vigilant, multidisciplinary surveillance – particularly for early sinonasal complications and evolving endocrine deficiencies – to optimize long-term QoL outcomes after EEA.

 

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