Implementing A Multidisciplinary Approach For Management Of Pituitary Macrodenoma In A Resource-Constrained Setting

Case Series And Literature Review

Abstract

Background: Pituitary adenomas constitute 10-15% of intracranial tumours; optimal care of these neoplasms necessitates a multidisciplinary approach due to their complex presentation and treatment needs. This study aims to evaluate the implementation of multidisciplinary care in a resource-constrained setting and analyse patient outcomes. Methods: A retrospective analysis was conducted on 21 patients who underwent treatment for pituitary adenomas at The Nairobi Hospital between 2004 and 2021. Data was extracted from medical records and encompassed patient demographics, clinical presentation, imaging results, treatment modalities, and outcomes. A literature study was conducted to contextualize the findings within the broader framework of existing research. Results: The predominant demographic of patients consisted of females (57.1%) and those aged 40 years or older (81%). The majority displayed visual impairment and headaches. The majority of patients received a diagnosis of macroadenomas. Treatment included surgical resection (47.6%) and medical management (42.9%). Endoscopic transsphenoidal surgery being the preferred surgical method. Despite positive surgical outcomes. Multidisciplinary care is constrained by a scarcity of specialists, such as endocrinologists and otolaryngologists, as well as by the elevated costs of treatment and inadequate access to diagnostic tools. Conclusion: The multidisciplinary care of pituitary adenomas improves surgical results, hormonal stabilization, and prognosis. The execution of such care is impeded by resource limitations, inadequate specialist availability, and restricted diagnostic skills in sub-Saharan Africa. It is advocated to establish Pituitary Tumour Centres of Excellence and to extend expert training to enhance patient outcomes in these settings.