Endocrine Function after Transsphenoidal Surgery in Patients with Non-Functioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

Abstract

Introduction: Transsphenoidal surgery is the current treatment for mass reduction in patients with non-functional pituitary adenomas (NFPAs). The surgical procedure may deteriorate or recover pituitary endocrine function. The aim of this study was to systematically assess the benefits and harms of transsphenoidal surgery on pituitary endocrine function in patients with NFPAs. Methods: This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42020210853). We searched Pubmed and EMBASE for studies reporting on pituitary function before and after transsphenoidal surgery in patients with NFPAs having a minimum follow-up of one month. The pre-specified primary outcomes were the proportions of patients with improved or deteriorated pituitary function after surgery reported as weighted mean using random effects meta-analysis or in case of considerable heterogeneity, i.e. I2 ≥ 75%, as a range of reported proportions. Subgroup analyses was planned for the primary outcomes on study level. Results: Of the 6597 identified records, 24 studies enrolling 3816 participants were eligible for assessment. Twenty-three studies were judged to have serious or critical risk of bias. The range of proportions of patients with recovery of at least one pituitary axis was between 10.2 % and 97.7 % (I2= 93 %), while the range of proportions of patients experiencing loss of at least one axis after pituitary surgery was between 0.0 % and 36.6 % (I2= 91 %). Conclusions: The current systematic review finds that the endocrine effect of pituitary surgery is unclear both in terms of the chance of recovery and the risk of pituitary failure and hypopituitarism should be considered only a relative indication for surgery. However, the range of effects does include potentially clinically relevant rates of pituitary recovery calling for more systematic collection of data in future studies.

Post-Operative Medium- and Long-Term Endocrine Outcomes in Patients with Non-Functioning Pituitary Adenomas—Machine Learning Analysis

“…Hypopituitarism refers to partial or complete loss of hormones produced by adenohypophysis or neurohypophysis that can be caused by several aetiologies causing damage in the hypothalamic-pituitary region. Pituitary adenomas and treatment with surgery and radiotherapy are considered the most common causes of hypopituitarism [6,20,21]. Clinical symptoms and presentation can be variable, from subclinical disease to life-threatening emergencies, dependent on the degree of hormone deficiency.…”

“…A substantial number of patients with NFPAs develop a degree of hypopituitarism due to mechanical compression of the pituitary gland and reduction of pituitary portal circulation [1,5]. In addition, treatment with surgery with and without adjuvant radiotherapy may increase the risk of developing further pituitary impairment [4,[6][7][8]. Currently, there are limited predictive models for post-operative endocrine outcomes in patients with NFPAs.…”

Natural History of Non-Functioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

“…This is an obvious important outcome and to our knowledge this is the first time for a systematic review to report on this outcome. As described previously [3] surgery may be performed due to chiasma pressure or for recovery of pituitary function, with the later not being practiced all places, which may contribute to the differences in estimates.…”

“…Non-functioning pituitary tumors (NFPTs) are non-secreting benign tumors of the pituitary gland and are diagnosed due to endocrinopathies or mass effect causing visual defects, or as nonfunctioning pituitary incidentalomas (NFPIs) on imaging performed for purposes not related to the pituitary gland [1]. Transsphenoidal surgery, or a combination of surgery and radiotherapy, is recommended as the primary treatment for NFPTs causing mass effect symptoms [2] while surgery of hypopituitarism is considered a relative indication [3]. However, conservative management of NFPTs in respect to frequency of imaging and biochemical assessment of pituitary function relies on risk estimates of tumor growth and de-velopment of new endocrinopathies, that is, natural history of NFPTs.…”

“…One outlier removed, Sam et al[30], changing the estimate to 1.6/100 PYs (95 % CI. 0.8 to 2.4; I 2 = 49 %)3 One outlier removed, Arita et al[21], changing the estimate to 0.4/100 PYs (95 % Cl. 0.1 to 0.8; I 2 = 32 %)4 One outlier removed, Carsote et al[24], changing the estimate to 3.7/100 PYs (95 % Cl.…”