Taiwan hospital meets Pituitary Society care standards, study finds
Taipei Veterans General Hospital aligns with Centers of Excellence criteria
Care practices at a hospital in Taiwan align with those recommended by the Pituitary Society for patients with pituitary tumors, including those causing Cushing’s disease, a study found.
The study found that practices at Taipei Veterans General Hospital fostered successful surgical interventions, a low risk of death, and a well-coordinated team of specialists.
“The multidisciplinary team … collaborated closely to provide comprehensive care for patients with pituitary tumors,” the researchers wrote in the study, “Evaluating pituitary tumor management: aligning with pituitary tumor centers of excellence criteria,” published in Pituitary.
Cushing’s is caused by a tumor in the brain’s pituitary gland, which leads to excessive release of adrenocorticotropic hormone. This hormone signals the adrenal glands above the kidneys to produce cortisol, which, in excess, can result in a range of symptoms. A pituitary tumor can also lead to excessive release of other hormones.
The Pituitary Society created a set of criteria to help hospitals become Pituitary Tumor Centers of Excellence (PTCOE). These centers focus on providing the best care for patients with pituitary tumors. Over time, the rules were turned into measurable standards using real-world data from leading hospitals worldwide. At the Taipei hospital, “most indicators in our study met the acceptable standards for a PTCOE,” the researchers wrote.
Review looks at success rates for surgery, remission
To assess how well Taipei Veterans General Hospital in Taiwan meets those standards, the researchers reviewed the medical records of 182 patients, aged 20 to 91, who underwent surgery to remove a pituitary tumor from 2021 to 2023. Five patients underwent two surgical interventions.
Surgery was performed using the endoscopic endonasal approach, where surgeons reach the tumor through the nostrils with the help of a camera placed at the end of a flexible tube, with minimal damage to the surrounding structures. Most patients (90.7%) had macroadenomas, meaning large tumors over 1 cm (0.39 inches) in size.
After surgery, most patients with Cushing’s (93.3%) achieved remission, meaning cortisol levels fell below 2 mcg/dL at their lowest point. Remission was achieved in more than half of patients with acromegaly (55.6%), where excess growth is caused by too much growth hormone, and prolactinoma (69.2%), a type of pituitary tumor that leads to excessive release of the hormone prolactin.
The hospital performed an average of 62 surgical interventions each year. The mortality rate was low at 0.2%. It was not related to surgery, but instead to aggressive somatotroph tumor disease — a pituitary tumor that produces too much growth hormone and grows uncontrollably despite treatment.
On average, 770 diagnostic tests were run each year. The most common was the dexamethasone suppression test, which can detect excessive cortisol production and its cause, with an average of 453 performed annually. Pituitary imaging included an average of 55 computed tomography (CT) scans and 1,162 MRI scans each year.
At the time of the study’s writing, Taipei Veterans General Hospital had seven endocrinologists — doctors with special training in diagnosing and treating diseases of the endocrine system (the organs that produce one or more hormones) — along with 12 trained nurses and 16 trained technicians.
According to the Pituitary Society, patients with pituitary tumors receive the best care at specialized centers with interdisciplinary teams composed of dedicated endocrinologists and neurosurgeons who use approaches like the endoscopic endonasal surgery.
“Our institute had the preferred number of endocrinologists and trained nurses or technicians for a PTCOE during the study period,” the researchers wrote, adding that “an acceptable number of dynamic endocrine [hormone] tests were performed annually.”
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