Evaluating Pituitary Tumor Management: Aligning with Pituitary Tumor Centers of Excellence Criteria

Evaluating Pituitary Tumor Management: Aligning with Pituitary Tumor Centers of Excellence Criteria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Evaluating Pituitary Tumor Management: Aligning with Pituitary Tumor Centers of Excellence Criteria Jin-Han Yang, Wei-Hsin Wang, Harn-Shen Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7108459/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background The Pituitary Society established criteria to develop Pituitary Tumor Centers of Excellence (PTCOE) for optimization of patient care. These criteria were later transformed into quantitative standards based on real-life data from accredited pituitary centers worldwide. The aim of this study was to evaluate the pituitary tumor care capacity at our institute and compare it with the PTCOE criteria. Method We retrospectively reviewed the data of patients who underwent sellar, suprasellar, or parasellar surgery during 2021–2023 at Taipei Veterans General Hospital. Adults older than 18 years who were diagnosed with pituitary tumors were included. We collected data regarding baseline patient and tumor characteristics, the surgical method, complications, and activity volumes across involved departments. The relevant data were compared with those of the PTCOE standards. Results In total, 182 patients with pituitary tumors underwent surgery via the endoscopic endonasal approach during 2021–2023. Their median age was 51 (range, 20–91) years. Among them, 90.7% had macroadenomas. Functional remission rates were 55.6% for acromegaly, 69.2% for prolactinoma, and 93.3% for Cushing’s disease. Our institute met the acceptable PTCOE criteria for the number of pituitary interventions, postoperative readmissions for complications, dynamic endocrine tests, neuroradiologists, and neuro-oncologists. Further, we met the preferred PTCOE criteria for mortality rate and the numbers of dedicated surgeons, endocrinologists, trained nurses, neuropathologists, and neuro-ophthalmologists. Conclusion Most indicators in our study met the acceptable standards for a PTCOE. During the study period, the multidisciplinary team at our institute collaborated closely to provide comprehensive care for patients with pituitary adenomas. Figures Figure 1 Introduction Pituitary adenomas are usually benign; however, affected patients may have comorbidities that influence their quality of life and further reduced their life expectancy[ 1 ]. Therefore, diagnosis and appropriate individualized management are important. Owing to the low incidence of pituitary adenomas and the need for complex interventions, the concept of “centers of excellence” has been proposed to ensure more specialized management and optimal patient care for this condition. In 2017, the Pituitary Society generated criteria for the development of a PTCOE, in which the general characteristics and mission of PTCOEs were defined. [ 2 ]. Later, Giustina et al. investigated nine pituitary centers with a worldwide reputation to survey and evaluate the activity in the pituitary field. They transformed the definition of an accredited PTCOE from qualitative parameters to quantitative criteria according to real-world data[ 3 ]. With the increase in awareness of care for patients with pituitary tumors, a comprehensive investigation of such care at our institute became necessary. In this study, we aimed to investigate our pituitary tumor care capacity by collecting the numerical data associated with pituitary adenoma surgery and the numbers of involved specialists. We also aimed to compare our real-life circumstances with the published criteria for PTCOEs. Method We retrospectively reviewed the medical charts of patients who underwent sellar, suprasellar, or parasellar surgery from Jan 1st, 2021, to Dec 31st, 2023, at Taipei Veterans General Hospital. Patients who were older than 18 years and were diagnosed with pituitary tumors were included. Patients with diagnoses other than pituitary tumors were excluded. Patient baseline characteristics, tumor characteristics, tumor-related symptoms, functional examinations, operative method, surgical complications, and post-operative hormone insufficiency were recorded. We also gathered information on personnel and activity volume from other supporting units at our hospital. This study was based in part on data from the Big Data Center, Taipei Veterans General Hospital. The interpretation and conclusions contained herein do not represent the position of the hospital. The study was approved by the institutional review board of the hospital under approval code 2025-02-001AC, and performed in compliance with the tenets of the Declaration of Helsinki. Postoperative biochemical remission or functional remission was defined as follows: for acromegaly, normalization of IGF-1 concentration according to the patient’s age at 12 weeks after the surgery [ 4 ]; for Cushing’s disease, postoperative serum cortisol concentrations lower than 2 µg/dL when monitored until postoperative cortisol nadir[ 5 ]; for prolactinoma, postoperative normalization of prolactin serum levels [ 6 ]; and for gonadotroph adenomas or other non-functioning pituitary adenomas (NFPAs), recovery from disease-induced abnormal hormone secretion 4–8 weeks after surgery, without the need for hormone replacement in patients who had had pituitary hormone deficiencies before surgery[ 7 , 8 ]. Postoperative hypopituitarism was diagnosed according to laboratory tests or symptoms related to hormonal deficiency, and the use of hormone replacement therapy. Major complications were defined as mortality related to complications of the surgery, the need for re-operation, or impairments in physical function within 30 days postoperatively. Long-term hypopituitarism was defined as the need for hormone replacement therapy for more than 3 months after the operation. Descriptive statistics were used to present case counts. Continuous variables were presented as means and standard deviations. Statistical analysis was performed using IBM SPSS Version 25.0 (IBM Corp., Armonk, NY, USA). Results In total, 397 patients underwent sellar, suprasellar, or parasellar surgery during 2021–2023 at Taipei Veterans General Hospital. Of these, 215 patients were excluded owing to diagnoses other than pituitary tumors (Fig. 1 ). The remaining 182 patients underwent endoscopic endonasal approach (EEA) for pituitary tumor removal during the study period, males accounting for 54.4% of the sample. Their median age was 51 (range: 20–91) years. Five patients underwent two surgical interventions, two of which because of postoperative complications, two because of experiencing tumor recurrence, and one because of a residual tumor. Therefore, a total of 187 EEA surgical interventions were performed during the reviewing period. Macroadenomas accounted for 90.7% of tumors, and the most common tumor type was gonadotroph adenoma. In total, 105 patients experienced optic chiasm compression before the operation, of whom 86 (81.9%) had postoperative vision improvement. Eighteen patients underwent postoperative Gamma Knife surgery. Seven episodes (3.8%) of major complications occurred, including two strokes, two hemorrhages, one hydrocephalus leading to ventriculoperitoneal shunt placement after the operation, one mucocele-related mass effect that led to re-operation, and one cerebrospinal fluid (CSF) leakage leading to re-operation 2 weeks later. In total, 20 patients developed hypopituitarism after the operation requiring long-term hormone replacement. Functional remission after the operation was achieved in 55.6% of patients with acromegaly, 93.3% with Cushing’s disease, and 69.2% with prolactinoma. Forty percent of the patients with NFPAs still required hormone replacement after the operation. The core activity data and the personnel involved in the treatment of patients with pituitary tumors at our hospital are listed in Table 1 . In total, 62 pituitary interventions were done per year in average, with mortality rate of 0.2%. 770 dynamic endocrine tests were performed per year during the study period. Dexamethasone suppression tests were performed most frequently, with an average of 453 tests per year. Inferior petrosal sinus sampling was performed five times per year in average. The average annual number of pituitary CT scans was 55, and that of pituitary contrast MRI scans was 1162. Table 1 Core activity data and activity volumes at our institute. Number per year Neurosurgery unit Pituitary interventions 62 Patients with complications requiring inpatient readmission within 30 days (%) 7 (3.8%) 1 Mortality (%) 0.2% 2 Personnel Dedicated surgeons 5 Trained nurses 12 Trained technicians 16 Endocrinology unit Dynamic examinations 770 Personnel Endocrinologists 7 Trained nurses/technicians 12 Supporting units Neuroradiologists 2 Sellar MRIs and CT scans 1217 Sellar MRIs 1162 IPSS cases 5.3 Radiation therapy (gamma knife) cases 6 Neuropathologists 3 Neuro-oncologists 2 Neuro-ophthalmologists 2 1 Complications either requiring re-operation or resulting in impairment of physical function. 2 The one who had refractory disease of somatotroph tumor despite re-operation for recurrence tumor removal and medication treatment. PTCOE, Pituitary Tumor Center of Excellence IPSS, inferior petrosal sinus sampling Discussion In this study, we comprehensively examined the core activities related to pituitary tumors at our hospital. We found that most items were within the acceptable range for PTCOEs according to published recommendations. The mortality rate, numbers of dedicated surgeons, endocrinologists, trained nurses, neuropathologists, and neuro-ophthalmologists also met the preferred criteria. The introducing of multidisciplinary team in management of pituitary adenoma has been shown to have benefits. Previous studies have shown shorter hospital stay, less intrasellar residual tumor, less complication rate, and decreased readmission rate after implementing of pituitary multidisciplinary team[ 9 – 12 ]. A proportion of these patients require medical therapy or radiotherapy after the operation. For instance, patients with growth-hormone secreting adenoma had post-operative biochemical remission rate of 51%-73.1% [ 13 – 15 ]. This underscores the importance of an endocrinology unit and other supporting unit for long-term follow-up and ongoing management of such patients. Our institute had the preferred number of endocrinologists and trained nurses or technicians for a PTCOE during the study period. An acceptable number of dynamic endocrine tests were performed annually. Notably, more dexamethasone suppression tests were conducted than ACTH stimulation tests, likely owing to their convenience in an outpatient setting. Additionally, the capacity of the other supporting units at our institute met the acceptable criteria for a PTCOE. The major surgical-complication rate in our study was 3.8%, meeting the acceptable criteria (< 10%) for a PTCOE[ 3 ]. This result corresponds with a multicenter analysis of 1240 patients who underwent transsphenoidal surgery, 6.9% experienced major complications, and the mortality rate was 0.7% [ 16 ]. Hypopituitarism developed in 11.0% of patients, most cases involving anterior hypopituitarism that required both cortisol and thyroxine replacement therapy. In previous studies, anterior pituitary insufficiency rates of 19% and diabetes insipidus rates of 18% were reported, with hypopituitarism rates varying from 5–31% depending on the neurosurgeon’s experience and tumor characteristics[ 17 – 20 ]. In this report, we examined the capacity of pituitary tumor care at our hospital. The multidisciplinary team at our center collaborated closely to provide comprehensive care for patients with pituitary tumors. Declarations Acknowledgments This study was supported by funding from the Taipei Veterans General Hospital (V107C-066) and National Science Council (NSTC 111-2314-B-A49-064-). The authors thank the Maintenance Project of the Big Data Center, Taipei Veterans General Hospital (BDC, TPEVGH) for their support in retrieving the data. We would like to thank Uni-edit (www.uni-edit.net) for editing and proofreading this manuscript. Author contributions JHY collected clinical data, wrote the manuscript, and contributed to the discussion. WHW provided substantial insights into study design and participated in data collection. HSC takes full responsibility for the work, including the study design, access to data, and the decision to submit and publish the manuscript. Conflict of interest disclosure The authors have no conflicts of interest to declare. Ethics approval The study was approved by the institutional review board, Taipei Veterans General Hospital, under approval code 2025-02-001AC, in compliance with the tenets of the Declaration of Helsinki. Data availability statement Research data are not publicly available. Requests for data access may be considered by the authors on a case-by-case basis. References Melmed S, Kaiser UB, Lopes MB, Bertherat J, Syro LV, Raverot G , et al. Clinical Biology of the Pituitary Adenoma. Endocr Rev. 2022;43(6):1003-37. Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS , et al. Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement. Pituitary. 2017;20(5):489-98. Giustina A, Uygur MM, Frara S, Barkan A, Biermasz NR, Chanson P , et al. Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE): results of an audit of leading international centers. Pituitary. 2023;26(5):583-96. Giustina A, Biermasz N, Casanueva FF, Fleseriu M, Mortini P, Strasburger C , et al. Consensus on criteria for acromegaly diagnosis and remission. Pituitary. 2024;27(1):7-22. Fleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR , et al. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol. 2021;9(12):847-75. Petersenn S, Fleseriu M, Casanueva FF, Giustina A, Biermasz N, Biller BMK , et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat Rev Endocrinol. 2023;19(12):722-40. Esposito D, Olsson DS, Ragnarsson O, Buchfelder M, Skoglund T, Johannsson G. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019;22(4):422-34. Mavromati M, Mavrakanas T, Jornayvaz FR, Schaller K, Fitsiori A, Vargas MI , et al. The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas. Endocrine. 2023;81(2):340-8. Grayson JW, Nayak A, Winder M, Jonker B, Alvarado R, Barham H , et al. Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma. J Neurol Surg B Skull Base. 2021;82(3):295-302. Ghiam MK, Ali IA, Dable CL, Ayala AR, Kargi AY, Komotar RJ , et al. Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care. J Neurol Surg B Skull Base. 2022;83(6):626-34. Carminucci AS, Ausiello JC, Page-Wilson G, Lee M, Good L, Bruce JN , et al. OUTCOME OF IMPLEMENTATION OF A MULTIDISCIPLINARY TEAM APPROACH TO THE CARE OF PATIENTS AFTER TRANSSPHENOIDAL SURGERY. Endocr Pract. 2016;22(1):36-44. Mercado M, Gonzalez B, Vargas G, Ramirez C, de los Monteros AL, Sosa E , et al. Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab. 2014;99(12):4438-46. Asha MJ, Takami H, Velasquez C, Oswari S, Almeida JP, Zadeh G , et al. Long-term outcomes of transsphenoidal surgery for management of growth hormone-secreting adenomas: single-center results. J Neurosurg. 2020;133(5):1360-70. Kim JH, Hur KY, Lee JH, Lee JH, Se YB, Kim HI , et al. Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly. World Neurosurg. 2017;104:272-8. Chen CJ, Ironside N, Pomeraniec IJ, Chivukula S, Buell TJ, Ding D , et al. Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir (Wien). 2017;159(11):2193-207. Cote DJ, Dasenbrock HH, Muskens IS, Broekman MLD, Zaidi HA, Dunn IF , et al. Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors. J Am Coll Surg. 2017;224(5):971-9. Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab. 2017;8(3):33-48. Roelfsema F, Biermasz NR, Pereira AM. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. Pituitary. 2012;15(1):71-83. Elshazly K, Kshettry VR, Farrell CJ, Nyquist G, Rosen M, Evans JJ. Clinical Outcomes After Endoscopic Endonasal Resection of Giant Pituitary Adenomas. World Neurosurg. 2018;114:e447-e56. Molteni G, Caiazza N, Fulco G, Sacchetto A, Gulino A, Marchioni D. Functioning Endocrine Outcome after Endoscopic Endonasal Transsellar Approach for Pituitary Neuroendocrine Tumors. J Clin Med. 2023;12(8). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Jul, 2025 Reviews received at journal 15 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviewers invited by journal 14 Jul, 2025 Editor assigned by journal 14 Jul, 2025 Submission checks completed at journal 14 Jul, 2025 First submitted to journal 12 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7108459","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":485971976,"identity":"0a774c4f-2935-47c2-a4d7-0f9c6d324d1a","order_by":0,"name":"Jin-Han Yang","email":"","orcid":"","institution":"Taipei Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jin-Han","middleName":"","lastName":"Yang","suffix":""},{"id":485971977,"identity":"50f8d9cc-a5ab-4f47-b7b5-ebbdbdf60392","order_by":1,"name":"Wei-Hsin Wang","email":"","orcid":"","institution":"Taipei Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei-Hsin","middleName":"","lastName":"Wang","suffix":""},{"id":485971978,"identity":"08acc1cc-52d7-41f3-b384-50ce17495944","order_by":2,"name":"Harn-Shen Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDACCQYGZgYGGzCDJC1pQAYzTIgZn3q4lsMkaOGf3XzsccGf84nzo/uPPfjAUCtncID/GF5HStw5lm48s+124sY7h9kNZzAcNzY4wMyGV4uBRI6ZNG/DbWPDGcls0jwMxxJnNjCz3cCvJf+bNM+fcxAtf4jTkgM0nO2AnLwEUAsDQ01iPwMBLRI30oAOa0uWM5BINjfsMThgzM/MbP4Dnxb+GcnPgA6z45GfkfjswY+KOjk29sbHBvi0IFx4gIENSB4mHJNwIN8A0sJQR6z6UTAKRsEoGEEAAC1VQMghbDmOAAAAAElFTkSuQmCC","orcid":"","institution":"Taipei Veterans General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Harn-Shen","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-07-12 13:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7108459/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7108459/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87047451,"identity":"b5a1c713-8fdc-457b-87e5-b1e72e82edb8","added_by":"auto","created_at":"2025-07-18 14:42:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39314,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of patient selection process.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7108459/v1/5cf7da578c2c736ccccff32e.png"},{"id":87047455,"identity":"edb84ce2-22df-49b0-9ec9-c66b39c1ba65","added_by":"auto","created_at":"2025-07-18 14:42:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":398092,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7108459/v1/c79ff4e8-1fb9-433c-af04-5543a6e24941.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating Pituitary Tumor Management: Aligning with Pituitary Tumor Centers of Excellence Criteria","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePituitary adenomas are usually benign; however, affected patients may have comorbidities that influence their quality of life and further reduced their life expectancy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, diagnosis and appropriate individualized management are important.\u003c/p\u003e\u003cp\u003eOwing to the low incidence of pituitary adenomas and the need for complex interventions, the concept of “centers of excellence” has been proposed to ensure more specialized management and optimal patient care for this condition. In 2017, the Pituitary Society generated criteria for the development of a PTCOE, in which the general characteristics and mission of PTCOEs were defined. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Later, Giustina et al. investigated nine pituitary centers with a worldwide reputation to survey and evaluate the activity in the pituitary field. They transformed the definition of an accredited PTCOE from qualitative parameters to quantitative criteria according to real-world data[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e With the increase in awareness of care for patients with pituitary tumors, a comprehensive investigation of such care at our institute became necessary. In this study, we aimed to investigate our pituitary tumor care capacity by collecting the numerical data associated with pituitary adenoma surgery and the numbers of involved specialists. We also aimed to compare our real-life circumstances with the published criteria for PTCOEs.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eWe retrospectively reviewed the medical charts of patients who underwent sellar, suprasellar, or parasellar surgery from Jan 1st, 2021, to Dec 31st, 2023, at Taipei Veterans General Hospital. Patients who were older than 18 years and were diagnosed with pituitary tumors were included. Patients with diagnoses other than pituitary tumors were excluded. Patient baseline characteristics, tumor characteristics, tumor-related symptoms, functional examinations, operative method, surgical complications, and post-operative hormone insufficiency were recorded. We also gathered information on personnel and activity volume from other supporting units at our hospital. This study was based in part on data from the Big Data Center, Taipei Veterans General Hospital. The interpretation and conclusions contained herein do not represent the position of the hospital. The study was approved by the institutional review board of the hospital under approval code 2025-02-001AC, and performed in compliance with the tenets of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003ePostoperative biochemical remission or functional remission was defined as follows: for acromegaly, normalization of IGF-1 concentration according to the patient’s age at 12 weeks after the surgery [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; for Cushing’s disease, postoperative serum cortisol concentrations lower than 2 µg/dL when monitored until postoperative cortisol nadir[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]; for prolactinoma, postoperative normalization of prolactin serum levels [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]; and for gonadotroph adenomas or other non-functioning pituitary adenomas (NFPAs), recovery from disease-induced abnormal hormone secretion 4–8 weeks after surgery, without the need for hormone replacement in patients who had had pituitary hormone deficiencies before surgery[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Postoperative hypopituitarism was diagnosed according to laboratory tests or symptoms related to hormonal deficiency, and the use of hormone replacement therapy. Major complications were defined as mortality related to complications of the surgery, the need for re-operation, or impairments in physical function within 30 days postoperatively. Long-term hypopituitarism was defined as the need for hormone replacement therapy for more than 3 months after the operation.\u003c/p\u003e\u003cp\u003eDescriptive statistics were used to present case counts. Continuous variables were presented as means and standard deviations. Statistical analysis was performed using IBM SPSS Version 25.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 397 patients underwent sellar, suprasellar, or parasellar surgery during 2021\u0026ndash;2023 at Taipei Veterans General Hospital. Of these, 215 patients were excluded owing to diagnoses other than pituitary tumors (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The remaining 182 patients underwent endoscopic endonasal approach (EEA) for pituitary tumor removal during the study period, males accounting for 54.4% of the sample. Their median age was 51 (range: 20\u0026ndash;91) years. Five patients underwent two surgical interventions, two of which because of postoperative complications, two because of experiencing tumor recurrence, and one because of a residual tumor. Therefore, a total of 187 EEA surgical interventions were performed during the reviewing period. Macroadenomas accounted for 90.7% of tumors, and the most common tumor type was gonadotroph adenoma. In total, 105 patients experienced optic chiasm compression before the operation, of whom 86 (81.9%) had postoperative vision improvement. Eighteen patients underwent postoperative Gamma Knife surgery.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSeven episodes (3.8%) of major complications occurred, including two strokes, two hemorrhages, one hydrocephalus leading to ventriculoperitoneal shunt placement after the operation, one mucocele-related mass effect that led to re-operation, and one cerebrospinal fluid (CSF) leakage leading to re-operation 2 weeks later. In total, 20 patients developed hypopituitarism after the operation requiring long-term hormone replacement.\u003c/p\u003e\u003cp\u003eFunctional remission after the operation was achieved in 55.6% of patients with acromegaly, 93.3% with Cushing\u0026rsquo;s disease, and 69.2% with prolactinoma. Forty percent of the patients with NFPAs still required hormone replacement after the operation.\u003c/p\u003e\u003cp\u003eThe core activity data and the personnel involved in the treatment of patients with pituitary tumors at our hospital are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In total, 62 pituitary interventions were done per year in average, with mortality rate of 0.2%. 770 dynamic endocrine tests were performed per year during the study period. Dexamethasone suppression tests were performed most frequently, with an average of 453 tests per year. Inferior petrosal sinus sampling was performed five times per year in average. The average annual number of pituitary CT scans was 55, and that of pituitary contrast MRI scans was 1162.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCore activity data and activity volumes at our institute.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber per year\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeurosurgery unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePituitary interventions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients with complications requiring inpatient readmission within 30 days (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (3.8%) \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.2% \u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonnel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDedicated surgeons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrained nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrained technicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndocrinology unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDynamic examinations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e770\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonnel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndocrinologists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrained nurses/technicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupporting units\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeuroradiologists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSellar MRIs and CT scans\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1217\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSellar MRIs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1162\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIPSS cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiation therapy (gamma knife) cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeuropathologists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeuro-oncologists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeuro-ophthalmologists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e1\u003c/sup\u003e Complications either requiring re-operation or resulting in impairment of physical function.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e2\u003c/sup\u003e The one who had refractory disease of somatotroph tumor despite re-operation for recurrence tumor removal and medication treatment.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003ePTCOE, Pituitary Tumor Center of Excellence\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eIPSS, inferior petrosal sinus sampling\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we comprehensively examined the core activities related to pituitary tumors at our hospital. We found that most items were within the acceptable range for PTCOEs according to published recommendations. The mortality rate, numbers of dedicated surgeons, endocrinologists, trained nurses, neuropathologists, and neuro-ophthalmologists also met the preferred criteria.\u003c/p\u003e\u003cp\u003eThe introducing of multidisciplinary team in management of pituitary adenoma has been shown to have benefits. Previous studies have shown shorter hospital stay, less intrasellar residual tumor, less complication rate, and decreased readmission rate after implementing of pituitary multidisciplinary team[\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A proportion of these patients require medical therapy or radiotherapy after the operation. For instance, patients with growth-hormone secreting adenoma had post-operative biochemical remission rate of 51%-73.1% [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This underscores the importance of an endocrinology unit and other supporting unit for long-term follow-up and ongoing management of such patients. Our institute had the preferred number of endocrinologists and trained nurses or technicians for a PTCOE during the study period. An acceptable number of dynamic endocrine tests were performed annually. Notably, more dexamethasone suppression tests were conducted than ACTH stimulation tests, likely owing to their convenience in an outpatient setting. Additionally, the capacity of the other supporting units at our institute met the acceptable criteria for a PTCOE.\u003c/p\u003e\u003cp\u003eThe major surgical-complication rate in our study was 3.8%, meeting the acceptable criteria (\u0026lt;\u0026thinsp;10%) for a PTCOE[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This result corresponds with a multicenter analysis of 1240 patients who underwent transsphenoidal surgery, 6.9% experienced major complications, and the mortality rate was 0.7% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Hypopituitarism developed in 11.0% of patients, most cases involving anterior hypopituitarism that required both cortisol and thyroxine replacement therapy. In previous studies, anterior pituitary insufficiency rates of 19% and diabetes insipidus rates of 18% were reported, with hypopituitarism rates varying from 5\u0026ndash;31% depending on the neurosurgeon\u0026rsquo;s experience and tumor characteristics[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this report, we examined the capacity of pituitary tumor care at our hospital. The multidisciplinary team at our center collaborated closely to provide comprehensive care for patients with pituitary tumors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by funding from the Taipei Veterans General Hospital (V107C-066) and National Science Council (NSTC 111-2314-B-A49-064-). The authors thank the Maintenance Project of the Big Data Center, Taipei Veterans General Hospital (BDC, TPEVGH) for their support in retrieving the data. We would like to thank Uni-edit (www.uni-edit.net) for editing and proofreading this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJHY collected clinical data, wrote the manuscript, and contributed to the discussion. WHW provided substantial insights into study design and participated in data collection. HSC takes full responsibility for the work, including the study design, access to data, and the decision to submit and publish the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest disclosure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review board, Taipei Veterans General Hospital, under approval code 2025-02-001AC, in compliance with the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch data are not publicly available. Requests for data access may be considered by the authors on a case-by-case basis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMelmed S, Kaiser UB, Lopes MB, Bertherat J, Syro LV, Raverot G\u003cem\u003e, et al.\u003c/em\u003e Clinical Biology of the Pituitary Adenoma. Endocr Rev. 2022;43(6):1003-37.\u003c/li\u003e\n\u003cli\u003eCasanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS\u003cem\u003e, et al.\u003c/em\u003e Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement. Pituitary. 2017;20(5):489-98.\u003c/li\u003e\n\u003cli\u003eGiustina A, Uygur MM, Frara S, Barkan A, Biermasz NR, Chanson P\u003cem\u003e, et al.\u003c/em\u003e Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE): results of an audit of leading international centers. Pituitary. 2023;26(5):583-96.\u003c/li\u003e\n\u003cli\u003eGiustina A, Biermasz N, Casanueva FF, Fleseriu M, Mortini P, Strasburger C\u003cem\u003e, et al.\u003c/em\u003e Consensus on criteria for acromegaly diagnosis and remission. Pituitary. 2024;27(1):7-22.\u003c/li\u003e\n\u003cli\u003eFleseriu M, Auchus R, Bancos I, Ben-Shlomo A, Bertherat J, Biermasz NR\u003cem\u003e, et al.\u003c/em\u003e Consensus on diagnosis and management of Cushing\u0026apos;s disease: a guideline update. Lancet Diabetes Endocrinol. 2021;9(12):847-75.\u003c/li\u003e\n\u003cli\u003ePetersenn S, Fleseriu M, Casanueva FF, Giustina A, Biermasz N, Biller BMK\u003cem\u003e, et al.\u003c/em\u003e Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat Rev Endocrinol. 2023;19(12):722-40.\u003c/li\u003e\n\u003cli\u003eEsposito D, Olsson DS, Ragnarsson O, Buchfelder M, Skoglund T, Johannsson G. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019;22(4):422-34.\u003c/li\u003e\n\u003cli\u003eMavromati M, Mavrakanas T, Jornayvaz FR, Schaller K, Fitsiori A, Vargas MI\u003cem\u003e, et al.\u003c/em\u003e The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas. Endocrine. 2023;81(2):340-8.\u003c/li\u003e\n\u003cli\u003eGrayson JW, Nayak A, Winder M, Jonker B, Alvarado R, Barham H\u003cem\u003e, et al.\u003c/em\u003e Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma. J Neurol Surg B Skull Base. 2021;82(3):295-302.\u003c/li\u003e\n\u003cli\u003eGhiam MK, Ali IA, Dable CL, Ayala AR, Kargi AY, Komotar RJ\u003cem\u003e, et al.\u003c/em\u003e Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care. J Neurol Surg B Skull Base. 2022;83(6):626-34.\u003c/li\u003e\n\u003cli\u003eCarminucci AS, Ausiello JC, Page-Wilson G, Lee M, Good L, Bruce JN\u003cem\u003e, et al.\u003c/em\u003e OUTCOME OF IMPLEMENTATION OF A MULTIDISCIPLINARY TEAM APPROACH TO THE CARE OF PATIENTS AFTER TRANSSPHENOIDAL SURGERY. Endocr Pract. 2016;22(1):36-44.\u003c/li\u003e\n\u003cli\u003eMercado M, Gonzalez B, Vargas G, Ramirez C, de los Monteros AL, Sosa E\u003cem\u003e, et al.\u003c/em\u003e Successful mortality reduction and control of comorbidities in patients with acromegaly followed at a highly specialized multidisciplinary clinic. J Clin Endocrinol Metab. 2014;99(12):4438-46.\u003c/li\u003e\n\u003cli\u003eAsha MJ, Takami H, Velasquez C, Oswari S, Almeida JP, Zadeh G\u003cem\u003e, et al.\u003c/em\u003e Long-term outcomes of transsphenoidal surgery for management of growth hormone-secreting adenomas: single-center results. J Neurosurg. 2020;133(5):1360-70.\u003c/li\u003e\n\u003cli\u003eKim JH, Hur KY, Lee JH, Lee JH, Se YB, Kim HI\u003cem\u003e, et al.\u003c/em\u003e Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly. World Neurosurg. 2017;104:272-8.\u003c/li\u003e\n\u003cli\u003eChen CJ, Ironside N, Pomeraniec IJ, Chivukula S, Buell TJ, Ding D\u003cem\u003e, et al.\u003c/em\u003e Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir (Wien). 2017;159(11):2193-207.\u003c/li\u003e\n\u003cli\u003eCote DJ, Dasenbrock HH, Muskens IS, Broekman MLD, Zaidi HA, Dunn IF\u003cem\u003e, et al.\u003c/em\u003e Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors. J Am Coll Surg. 2017;224(5):971-9.\u003c/li\u003e\n\u003cli\u003ePrete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab. 2017;8(3):33-48.\u003c/li\u003e\n\u003cli\u003eRoelfsema F, Biermasz NR, Pereira AM. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. Pituitary. 2012;15(1):71-83.\u003c/li\u003e\n\u003cli\u003eElshazly K, Kshettry VR, Farrell CJ, Nyquist G, Rosen M, Evans JJ. Clinical Outcomes After Endoscopic Endonasal Resection of Giant Pituitary Adenomas. World Neurosurg. 2018;114:e447-e56.\u003c/li\u003e\n\u003cli\u003eMolteni G, Caiazza N, Fulco G, Sacchetto A, Gulino A, Marchioni D. Functioning Endocrine Outcome after Endoscopic Endonasal Transsellar Approach for Pituitary Neuroendocrine Tumors. J Clin Med. 2023;12(8).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pituitary","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pitu","sideBox":"Learn more about [Pituitary]()","snPcode":"11102","submissionUrl":"https://submission.nature.com/new-submission/11102/3","title":"Pituitary","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7108459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7108459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe Pituitary Society established criteria to develop Pituitary Tumor Centers of Excellence (PTCOE) for optimization of patient care. These criteria were later transformed into quantitative standards based on real-life data from accredited pituitary centers worldwide. The aim of this study was to evaluate the pituitary tumor care capacity at our institute and compare it with the PTCOE criteria.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003e We retrospectively reviewed the data of patients who underwent sellar, suprasellar, or parasellar surgery during 2021\u0026ndash;2023 at Taipei Veterans General Hospital. Adults older than 18 years who were diagnosed with pituitary tumors were included. We collected data regarding baseline patient and tumor characteristics, the surgical method, complications, and activity volumes across involved departments. The relevant data were compared with those of the PTCOE standards.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn total, 182 patients with pituitary tumors underwent surgery via the endoscopic endonasal approach during 2021\u0026ndash;2023. Their median age was 51 (range, 20\u0026ndash;91) years. Among them, 90.7% had macroadenomas. Functional remission rates were 55.6% for acromegaly, 69.2% for prolactinoma, and 93.3% for Cushing\u0026rsquo;s disease. Our institute met the acceptable PTCOE criteria for the number of pituitary interventions, postoperative readmissions for complications, dynamic endocrine tests, neuroradiologists, and neuro-oncologists. Further, we met the preferred PTCOE criteria for mortality rate and the numbers of dedicated surgeons, endocrinologists, trained nurses, neuropathologists, and neuro-ophthalmologists.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMost indicators in our study met the acceptable standards for a PTCOE. During the study period, the multidisciplinary team at our institute collaborated closely to provide comprehensive care for patients with pituitary adenomas.\u003c/p\u003e","manuscriptTitle":"Evaluating Pituitary Tumor Management: Aligning with Pituitary Tumor Centers of Excellence Criteria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:34:38","doi":"10.21203/rs.3.rs-7108459/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-15T21:18:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-15T15:16:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130318777819694752771492841520487540576","date":"2025-07-15T13:39:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T01:39:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-14T07:06:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-14T07:04:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pituitary","date":"2025-07-12T13:30:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pituitary","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pitu","sideBox":"Learn more about [Pituitary]()","snPcode":"11102","submissionUrl":"https://submission.nature.com/new-submission/11102/3","title":"Pituitary","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"75eac150-43b1-43c6-888a-8984cf8ecb90","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T08:38:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:34:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7108459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7108459","identity":"rs-7108459","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}