{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:54:43Z","timestamp":1785398083019,"version":"3.56.0"},"reference-count":28,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2021,3,6]],"date-time":"2021-03-06T00:00:00Z","timestamp":1614988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,18]]},"abstract":"Abstract<\/jats:title>\n \n Context<\/jats:title>\n Transsphenoidal surgery is standard care in the treatment of hormone-secreting pituitary adenomas. Current clinician-reported surgical outcome measures are one-dimensional, typically focusing primarily on complete or partial resection, and secondarily on complication rates. However, outcomes are best reflected by the delicate balance of efficacy and complications at patient level.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study proposes a novel way to classify and report outcomes, integrating efficacy and safety at the patient level.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Retrospective chart review of all pure endoscopic transsphenoidal surgical procedures for acromegaly, Cushing\u2019s disease, and prolactinoma between 2010 and 2018 in a single tertiary referral center. We present our results in a classic (remission and complications separate) and in a novel outcome square integrating both outcomes, focusing on intended and adverse effects (long-term complications). This resulted in 4 outcome groups, ranging from good to poor. We use this approach to present these outcomes for several subgroups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 198 surgical procedures were included (44 reoperations). Remission was achieved in 127 operations (64%). Good outcome was observed after 121 (61%), and poor outcome after 6 (3%) operations. When intended effect of surgery was applied (instead of remission), good outcome as intended was achieved after 148 of 198 surgeries (75%) and poor outcome after 4 (2%).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Quality of a surgical intervention can be presented in 4 simple categories, integrating both efficacy and safety with flexibility to adapt to the individualized situation at patient, disease, and surgical strategy and to the outcome of interest.<\/jats:p>\n <\/jats:sec>","DOI":"10.1210\/clinem\/dgab138","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T04:30:46Z","timestamp":1615437046000},"page":"e3300-e3311","source":"Crossref","is-referenced-by-count":19,"title":["Outcome Squares Integrating Efficacy and Safety, as Applied to Functioning Pituitary Adenoma Surgery"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3660-6093","authenticated-orcid":false,"given":"Friso","family":"de Vries","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2523-8707","authenticated-orcid":false,"given":"Daniel J","family":"Lobatto","sequence":"additional","affiliation":[{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9739-7515","authenticated-orcid":false,"given":"Marco J T","family":"Verstegen","sequence":"additional","affiliation":[{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter J","family":"Schutte","sequence":"additional","affiliation":[{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3625-0752","authenticated-orcid":false,"given":"Irene C","family":"Notting","sequence":"additional","affiliation":[{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Department of Ophthalmology, Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4319-834X","authenticated-orcid":false,"given":"Mark C","family":"Kruit","sequence":"additional","affiliation":[{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Department of Radiology, Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-5549","authenticated-orcid":false,"given":"S Faisal","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Developmental Endocrinology Research Group, School of Medicine, Dentistry & Nursing, University of Glasgow and Office for Rare Conditions, Royal Hospital for Children & Queen Elizabeth University Hospital, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1194-9866","authenticated-orcid":false,"given":"Alberto M","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5208-921X","authenticated-orcid":false,"given":"Wouter R","family":"van Furth","sequence":"additional","affiliation":[{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Department of Neurosurgery, Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-3594","authenticated-orcid":false,"given":"Nienke R","family":"Biermasz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, ZA Leiden, The Netherlands"},{"name":"Centre for Endocrine Tumours Leiden (CETL), Leiden University Medical Centre, ZA Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2021,3,6]]},"reference":[{"issue":"4","key":"2021120108535535700_CIT0001","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/SLA.0b013e31818a43af","article-title":"Value-based health care delivery","volume":"248","author":"Porter","year":"2008","journal-title":"Ann 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Neurosurg."},{"issue":"4","key":"2021120108535535700_CIT0008","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp","year":"1993","journal-title":"Neurosurgery."},{"issue":"2","key":"2021120108535535700_CIT0009","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/j.1365-2265.2006.02562.x","article-title":"Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas","volume":"65","author":"Casanueva","year":"2006","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"11","key":"2021120108535535700_CIT0010","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.1210\/jc.2014-2700","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson","year":"2014","journal-title":"J Clin Endocrinol Metab."},{"issue":"8","key":"2021120108535535700_CIT0011","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1210\/jc.2015-1818","article-title":"Treatment of Cushing\u2019s syndrome: an endocrine society clinical practice guideline","volume":"100","author":"Nieman","year":"2015","journal-title":"J Clin Endocrinol Metab."},{"issue":"9","key":"2021120108535535700_CIT0012","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/s41574-018-0058-5","article-title":"A Consensus Statement on acromegaly therapeutic outcomes","volume":"14","author":"Melmed","year":"2018","journal-title":"Nat Rev Endocrinol."},{"issue":"3","key":"2021120108535535700_CIT0013","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.ecl.2020.05.011","article-title":"Endoscopic surgery for pituitary tumors","volume":"49","author":"van Furth","year":"2020","journal-title":"Endocrinol Metab Clin North 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A systematic review and meta-analysis","author":"Zamanipoor Najafabadi","year":"2019","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"2021120108535535700_CIT0027","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1007\/s11102-018-0893-3","article-title":"Endoscopic vs. microscopic transsphenoidal surgery for Cushing\u2019s disease: a systematic review and meta-analysis","volume":"21","author":"Broersen","year":"2018","journal-title":"Pituitary."},{"issue":"5","key":"2021120108535535700_CIT0028","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s11102-018-0904-4","article-title":"The experience with transsphenoidal surgery and its importance to outcomes","volume":"21","author":"Honegger","year":"2018","journal-title":"Pituitary."}],"container-title":["The Journal of Clinical Endocrinology & Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgab138\/38935010\/dgab138.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/9\/e3300\/41379089\/dgab138.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/106\/9\/e3300\/41379089\/dgab138.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T13:41:14Z","timestamp":1638366074000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/106\/9\/e3300\/6161285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,6]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,3,6]]},"published-print":{"date-parts":[[2021,8,18]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgab138","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,9,1]]},"published":{"date-parts":[[2021,3,6]]}}}