{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:00:31Z","timestamp":1788321631537,"version":"build-2803163510"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003Despite multidisciplinary care being commonly recommended, there remains limited evidence supporting its benefits in pituitary disease management. This study aimed to assess the impact of multidisciplinary care in pituitary surgery.<\/jats:p><jats:p>\n          Methods\u2003A retrospective cohort study was performed comparing pituitary surgery outcomes among consecutive patients within a quaternary referral center in 5 years before and after introduction of a multidisciplinary team (MDT). Primary outcomes were endocrine (transient diabetes insipidus [DI], syndrome of inappropriate antidiuretic hormone [SIADH], and new hypopituitarism) and surgical (cerebrospinal fluid [CSF] leak, epistaxis, intracranial hemorrhage, and meningitis) complications, length of hospital stay, and intrasellar residual tumor.<\/jats:p><jats:p>\n          Results\u2003279 patients (89 pre-MDT vs. 190 post-MDT) were assessed (age 54\u2009\u00b1\u200917 years, 48% female). Nonfunctioning adenomas were most common (54%). In the post-MDT era, more clinically functioning tumors (42 vs. 28%, p\u2009=\u20090.03) were treated. Transient DI and SIADH occurred less often post-MDT (20 vs. 36%, p\u2009&lt;\u20090.01 and 18 vs. 39%, p\u2009&lt;\u20090.01), as well as new hypothyroidism (5 vs. 15, p\u2009&lt;\u20090.01). Hospital stay was shorter post-MDT (5[3] vs. 7[5] days, p\u2009&lt;\u20090.001) and intrasellar residuals were less common (8 vs. 35%, p\u2009&lt;\u20090.001). Complications were more frequent pre-MDT independent of tumor size, hormone status, and surgical technique (odds ratio [OR]\u2009=\u20092.14 [1.05\u20134.32], p\u2009=\u20090.04).<\/jats:p><jats:p>\n          Conclusion\u2003Outcomes of pituitary surgery improved after the introduction of an MDT. Pituitary MDTs may benefit both patients and the health system by improving quality of care and reducing hospital stays.<\/jats:p>","DOI":"10.1055\/s-0039-1700498","type":"journal-article","created":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T22:56:06Z","timestamp":1571698566000},"page":"295-302","source":"Crossref","is-referenced-by-count":17,"title":["Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma"],"prefix":"10.1055","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2131-8005","authenticated-orcid":false,"given":"Jessica W.","family":"Grayson","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnish","family":"Nayak","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Winder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Jonker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St Vincent's Hospital, Sydney, Australia"},{"name":"Department of Neurosurgery, Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia"},{"name":"Brain and Mind Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Alvarado","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Barham","sequence":"additional","affiliation":[{"name":"Sinus and Nasal Specialists of Louisiana, Louisiana, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"McCormack","sequence":"additional","affiliation":[{"name":"Hormones and Cancer Group, Garvan Institute of Medical Research, Sydney, Australia"},{"name":"St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia"},{"name":"Department of Endocrinology, St Vincent's Hospital, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Harvey","sequence":"additional","affiliation":[{"name":"Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia"},{"name":"Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,10,21]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/S1470-2045(06)70940-8","article-title":"Multidisciplinary teams in cancer care: are they effective in the UK?","volume":"7","author":"A Fleissig","year":"2006","journal-title":"Lancet Oncol"},{"key":"ref3","volume-title":"Improving Outcomes for People with Brain and Other CNS Tumours: The Manual","year":"2006"},{"key":"ref4","volume-title":"Analysis of the Potential Economic Impact of the Guidance: \u2018Improving Outcomes for People with Brain and Other CNS Tumours","author":"P Linck","year":"2006"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"c951","DOI":"10.1136\/bmj.c951","article-title":"Multidisciplinary team working in cancer: what is the evidence?","volume":"340","author":"C Taylor","year":"2010","journal-title":"BMJ"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/coa.12018","article-title":"The skull base multidisciplinary team approach: our experience over the first year in three hundred and seventeen patients","volume":"37","author":"J W Rainsbury","year":"2012","journal-title":"Clin Otolaryngol"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s11102-017-0838-2","article-title":"Criteria for the definition of pituitary tumor centers of excellence (PTCOE): a pituitary society statement","volume":"20","author":"F F Casanueva","year":"2017","journal-title":"Pituitary"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"522","DOI":"10.5694\/j.1326-5377.2007.tb01395.x","article-title":"Pituitary masses: the importance of a multidisciplinary approach","volume":"187","author":"W J Inder","year":"2007","journal-title":"Med J Aust"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.jocn.2008.09.002","article-title":"Surgical complications after endoscopic transsphenoidal pituitary surgery","volume":"16","author":"P Charalampaki","year":"2009","journal-title":"J Clin Neurosci"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1177\/0194599815617130","article-title":"Causes for 30-day readmission following transsphenoidal surgery","volume":"154","author":"B L Hendricks","year":"2016","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s11102-017-0802-1","article-title":"Surgical outcomes in patients with Cushing's disease: the Cleveland clinic experience","volume":"20","author":"P C Johnston","year":"2017","journal-title":"Pituitary"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s11102-008-0094-6","article-title":"Transsphenoidal surgery","volume":"11","author":"S M Joshi","year":"2008","journal-title":"Pituitary"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/JNN.0b013e3182828e28","article-title":"Managing the patient with transsphenoidal pituitary tumor resection","volume":"45","author":"W Yuan","year":"2013","journal-title":"J Neurosci Nurs"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.wneu.2016.04.059","article-title":"A benchmark for preservation of normal pituitary function after endoscopic transsphenoidal surgery for pituitary macroadenomas","volume":"91","author":"E R Laws Jr","year":"2016","journal-title":"World Neurosurg"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.wneu.2014.02.020","article-title":"Neurosurgical endocrinology, endocrinological neurosurgery and interdisciplinary work","volume":"83","author":"M Lund-Johansen","year":"2015","journal-title":"World Neurosurg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1017\/S031716710012075X","article-title":"Management of Cushing's disease after failed surgery--a review","volume":"38","author":"N McLaughlin","year":"2011","journal-title":"Can J Neurol Sci"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1210\/jc.2015-3653","article-title":"Pituitary medicine from discovery to patient-focused outcomes","volume":"101","author":"S Melmed","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1530\/eje.1.02036","article-title":"Consensus statement: medical management of acromegaly","volume":"153","author":"S Melmed","year":"2005","journal-title":"Eur J Endocrinol"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1210\/jc.2008-2421","article-title":"Guidelines for acromegaly management: an update","volume":"94","author":"S Melmed","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"751","DOI":"10.3171\/JNS\/2008\/109\/10\/0751","article-title":"Management of Cushing's disease: outcome in patients with microadenoma detected on pituitary magnetic resonance imaging","volume":"109","author":"D M Prevedello","year":"2008","journal-title":"J Neurosurg"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1365-2265.2010.03913.x","article-title":"UK guidelines for the management of pituitary apoplexy","volume":"74","author":"S Rajasekaran","year":"2011","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S1042-3680(02)00032-3","article-title":"Postoperative endocrine management of pituitary tumors","volume":"14","author":"P A Singer","year":"2003","journal-title":"Neurosurg Clin N Am"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1210\/jc.2011-3237","article-title":"Update on pituitary surgery","volume":"97","author":"B Swearingen","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"756069","DOI":"10.1155\/2015\/756069","article-title":"Clinical characteristics and treatment outcome of 485 patients with nonfunctioning pituitary macroadenomas","volume":"2015","author":"G Vargas","year":"2015","journal-title":"Int J Endocrinol"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2014.8.FOCUS14445","article-title":"Assessing the cost of contemporary pituitary care","volume":"37","author":"N McLaughlin","year":"2014","journal-title":"Neurosurg Focus"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1111\/j.1365-2265.2010.03875.x","article-title":"Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis","volume":"73","author":"M H Murad","year":"2010","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"09","key":"ref27","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1002\/alr.21356","article-title":"Significant increases of pituitary tumors and resections from 1993 to 2011","volume":"4","author":"J A Villwock","year":"2014","journal-title":"Int Forum Allergy Rhinol"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"E548","DOI":"10.1227\/01.neu.0000417706.27294.a2","article-title":"Improved resource utilization is associated with high volume surgical centers, low complication rates, and shorter length of stay in patients undergoing transsphenoidal surgery for cushing's disease","volume":"71","author":"A S Little","year":"2012","journal-title":"Neurosurgery"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3171\/2014.10.JNS14372","article-title":"Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas","volume":"123","author":"J A Gondim","year":"2015","journal-title":"J Neurosurg"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/foc.2007.23.3.9","article-title":"National trends, complications, and outcomes following transsphenoidal surgery for Cushing's disease from 1993 to 2002","volume":"23","author":"C G Patil","year":"2007","journal-title":"Neurosurg Focus"},{"issue":"09","key":"ref31","doi-asserted-by":"crossref","first-page":"4268","DOI":"10.1210\/jc.2010-0537","article-title":"Incidence of pituitary adenomas in Northern Finland in 1992-2007","volume":"95","author":"A Raappana","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"335","DOI":"10.4103\/1658-354X.136424","article-title":"Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study","volume":"8","author":"T Chowdhury","year":"2014","journal-title":"Saudi J Anaesth"},{"issue":"01","key":"ref33","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1227\/NEU.0000000000001003","article-title":"Delayed hyponatremia is the most common cause of 30-day unplanned readmission after transsphenoidal surgery for pituitary tumors","volume":"78","author":"M A Bohl","year":"2016","journal-title":"Neurosurgery"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/j.1365-2265.2007.03012.x","article-title":"Wide variation in surgical outcomes for acromegaly in the UK","volume":"68","author":"P R Bates","year":"2008","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"04","key":"ref35","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/cen.13007","article-title":"Quality indicators in pituitary surgery: a need for reliable and valid assessments. What should be measured?","volume":"84","author":"M Powell","year":"2016","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/00019052-200412000-00009","article-title":"Diagnosis and treatment of pituitary tumors","volume":"17","author":"J Kreutzer","year":"2004","journal-title":"Curr Opin Neurol"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1700498.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T22:31:39Z","timestamp":1621463499000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1700498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,21]]},"references-count":35,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2021,5,19]]},"published-print":{"date-parts":[[2021,6]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1700498","relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,21]]}}}