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Prognostic factors for outcome after transsphenoidal hypophysectomy in dogs with pituitary-dependent hyperadrenocorticism.

AbstractOBJECT:
The aim of this study was to determine prognostic factors for outcome after transsphenoidal hypophysectomy in dogs with pituitary-dependent hyperadrenocorticism (PDH).
METHODS:
One veterinary neurosurgeon performed transsphenoidal hypophysectomies in 181 dogs with PDH over a 12-year period. Survival analysis was performed with the Kaplan-Meier method. Prognostic factors were analyzed with the univariate Cox proportional hazard analysis followed by stepwise multivariate analysis. The log-rank test was used to assess disease-free fractions in three groups categorized according to early postoperative urinary corticoid/creatinine (C/C) ratios.
RESULTS:
Multivariate analysis revealed that old age, large pituitary size, and high preoperative concentrations of plasma adrenocorticotropic hormone were associated with an increased risk of PDH-related death. In addition, large pituitary size, thick sphenoid bone, high C/C ratio, and high concentration of plasma alpha-melanocyte-stimulating hormone (alpha-MSH) before surgery were associated with an increased risk of disease recurrence in the dogs that went into remission after hypophysectomy. Disease-free fractions were significantly higher in dogs with postoperative urinary C/C ratios in the lower normal range (< 5 x 10(-6)) than in dogs with postoperative C/C ratios in the upper normal range (5-10 x 10(-6)).
CONCLUSIONS:
The results of this study indicate that pituitary size, sphenoid bone thickness, plasma alpha-MSH concentration, and preoperative level of urinary cortisol excretion are predictors of long-term remission after transsphenoidal hypophysectomy for PDH in dogs. Urinary C/C ratios measured 6 to 10 weeks after surgery can be used as a guide for predicting the risk of tumor recurrence.
AuthorsJeanette M Hanson, Erik Teske, George Voorhout, Sara Galac, Hans S Kooistra, Björn P Meij
JournalJournal of neurosurgery (J Neurosurg) Vol. 107 Issue 4 Pg. 830-40 (Oct 2007) ISSN: 0022-3085 [Print] United States
PMID17937231 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Adrenocortical Hyperfunction (mortality, surgery, veterinary)
  • Animals
  • Dog Diseases (mortality, surgery)
  • Dogs
  • Female
  • Hypophysectomy (mortality, veterinary)
  • Male
  • Neoplasm, Residual (mortality)
  • Pituitary ACTH Hypersecretion (mortality, surgery, veterinary)
  • Pituitary Gland (surgery)
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Recurrence
  • Remission Induction
  • Risk Factors
  • Sphenoid Bone (surgery)
  • Survival Rate

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