CLINICAL AND IMMUNOHISTOCHEMICAL FEATURES OF INACTIVE PITUITARY ADENOMAS
Keywords:
inactive pituitary adenomas, relapsing course, invasivenessAbstract
Target. Early diagnosis of inactive pituitary adenoma (IPA) is an urgent problem not only in modern health care, including neuroendocrinology, but also a medical and social problem. Aggressive pituitary adenomas, which can recur after surgical treatment, are also a big problem. The study of pathological factors and the identification of proliferation markers makes it possible to predict further outcomes of postoperative pituitary adenomas, and may also affect the use of adjuvant therapy.
Material and methods. In the period from 2018 to 2022, 427 patients with various pituitary adenomas were operated on at the Neurosurgery Department of the RSSPMC of Endocrinology of the Republic of Uzbekistan using transsphenoidal transnasal adenomectomy. We selected the case histories of 125 patients with inactive pituitary adenomas with a recurrent course and invasive growth for retrospective analysis. Histological materials in the form of blocks for immunohistochemical studies (IHCS) were based on the expression of the proliferative index Ki-67 and p53.
Results. Among the 125 patients we selected, 67 had recurrent transsphenoidal pituitary adenomectomy, and 35 patients had invasive growth. The most common preoperative complaints were headaches, decreased visual acuity, visual field defects and sexual disorders: in 125 (100%), 53 (42.4%), 44 (35.2%) and 69 (55.2%) cases respectively. Hormonal disorders occurred in 95 patients (76%). After surgery, 99 patients (79.2%) required hormone replacement therapy with one or more drugs. 6 patients had visual symptoms associated with pituitary apoplexy and recovered after surgery. The Ki-67 labeling index ranged from ≥1% to 20%, the presence of p53 was noted in 101 (80.8%) patients.
Conclusion. In our study series, patients who developed growth relapse had a labeling index ≥3, and p53 levels were greater than ≥20%.
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