OBJECTIVE: The European Reference Network on Rare Endocrine Conditions (Endo-ERN) aims to organize high-quality healthcare throughout Europe, including care for pituitary adenoma patients. As surgery is the mainstay of treatment, we aimed to describe the current surgical practice and published surgical outcomes of pituitary adenoma within Endo-ERN. DESIGN AND METHODS: Systematic review and meta-analysis of studies reporting surgical outcomes of pituitary adenoma patients within Endo-ERN MTG6 pituitary reference centers between 2010 and 2019. A survey was completed by reference centers on their current surgical practice. RESULTS: A total of 18 out of 43 (42%) reference centers located in 7 of the 20 (35%) MTG6-represented countries published 48 articles. Remission rates were 50% (95% CI: 42-59) for patients with acromegaly, 68% (95% CI: 60-75) for Cushing's disease, and 53% (95% CI: 39-66%) for prolactinoma. Gross total resection was achieved in 49% (95% CI: 37-61%) of patients and visual improvement in 78% (95% CI: 68-87). Mortality, hemorrhage, and carotid injury occurred in less than 1% of patients. New-onset hypopituitarism occurred in 16% (95% CI: 11-23), transient diabetes insipidus in 12% (95% CI: 6-21), permanent diabetes insipidus in 4% (95% CI: 3-6), syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in 9% (95% CI: 5-14), severe epistaxis in 2% (95% CI: 0-4), and cerebrospinal fluid leak in 4% (95% CI: 2-6). Thirty-five (81%) centers completed the survey: 54% were operated endoscopically and 57% were together with an ENT surgeon. CONCLUSION: The results of this study could be used as a first benchmark for the outcomes of pituitary adenoma surgery within Endo-ERN. However, the heterogeneity between studies in the reporting of outcomes hampers comparability and warrants outcome collection through registries.

Adult Chair and Coordinator of Endo ERN Department of Endocrinology and Metabolism Amsterdam University Medical Center Amsterdam The Netherlands

Adult Chair Main Thematic Group 6 Pituitary of Endo ERN Department of Medicine Division of Endocrinology and Centre for Endocrine Tumors Leiden University Medical Centre Leiden The Netherlands

Chair of Work Package of E Health and ICT of Endo ERN Developmental Endocrinology Research Group School of Medicine Dentistry and Nursing University of Glasgow and Office for Rare Conditions Royal Hospital for Children and Queen Elizabeth University Hospital Glasgow UK

Department of Medicine Division of Endocrinology and Centre for Endocrine Tumors Leiden University Medical Centre Leiden The Netherlands

Department of Neurosurgery University Neurosurgical Centre Holland Leiden University Medical Centre Haaglanden Medical Centre and Haga Teaching Hospitals Leiden and The Hague The Netherlands

Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands

Dutch Pituitary Foundation European Patient Advocacy Group Nijkerk The Netherlands

London Centre for Pediatric Endocrinology and Diabetes at Great Ormond Street Children's Hospital and University College London Hospitals London UK

Pediatric Chair and Deputy Coordinator of Endo ERN Division of Pediatric Endocrinology and Diabetes Department of Pediatrics and Adolescent Medicine University of Lübeck Lübeck Germany

Pediatric Chair Main Thematic Group 6 Pituitary of Endo ERN Division of Endocrinology Metabolism and Diabetes 1st Department of Pediatrics National and Kapodistrian University of Athens Medical School 'Aghia Sophia' Children's Hospital Athens Greece

SOD ITALIA European Patient Advocacy Group Rome Italy

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