Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis

Abstract

aBBreViatiONS ACTH = adrenocorticotropic hormone; FSH = follicle-stimulating hormone; GH = growth hormone; GnRH = gonadotropin-releasing hormone; IGF-1= insulin-like growth factor-1; LH = luteinizing hormone; NFA = nonfunctional adenoma; T4 = thyroxine; TRH = thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone. SuBmitted October 10, 2014. accepted January 13, 2015. iNclude wheN citiNg Published online August 7, 2015; DOI: 10.3171/2015.1.JNS141543. diSclOSure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. * Mr. Jahangiri and Mr. Wagner contributed equally to this work. OBJectiVe The impact of transsphenoidal surgery for nonfunctional pituitary adenomas (NFAs) on preoperative hypopituitarism relative to the incidence of new postoperative endocrine deficits remains unclear. The authors investigated rates of hypopituitarism resolution and development after transsphenoidal surgery. methOdS Over a 5-year period, 305 transsphenoidal surgeries for NFAs performed at The California Center for Pituitary Disorders were retrospectively reviewed. reSultS Patients with preoperative endocrine deficits (n = 153, 50%) were significantly older (mean age 60 vs 54 years; p = 0.004), more frequently male (65% vs 44%; p = 0.0005), and had larger adenomas (2.4 cm vs 2.1 cm; p = 0.02) than patients without preoperative deficits (n = 152, 50%). Of patients with preoperative endocrine deficits, 53% exhibited symptoms. Preoperative deficit rates were 26% for the thyroid axis; 20% and 16% for the male and female reproductive axes, respectively; 13% for the adrenocorticotropic hormone (ACTH)/cortisol axis, and 19% for the growth hormone (GH)/ insulin-like growth factor-1 (IGF-1) axis. Laboratory normalization rates 6 weeks and 6 months after surgery without hormone replacement were 26% and 36% for male and 13% and 13% for female reproductive axes, respectively; 30% and 49% for the thyroid axis; 3% and 3% for the cortisol axis; and 9% and 22% for the IGF-1 axis (p < 0.05). New postoperative endocrine deficits occurred in 42 patients (13.7%). Rates of new deficits by axes were: male reproductive 3% (n = 9), female reproductive 1% (n = 4), thyroid axis 3% (n = 10), cortisol axis 6% (n = 19), and GH/IGF-1 axis 4% (n = 12). Patients who failed to exhibit any endocrine normalization had lower preoperative gland volumes than those who did not (0.24 cm 3 vs 0.43 cm 3 , respectively; p < 0.05). Multivariate analyses revealed that no variables predicted new postoperative deficits or normalization of the female reproductive, cortisol, and IGF-1 axes. However, increased preoperative gland volume and younger age predicted the chances of a patient with any preoperative deficit experiencing normalization of at least 1 axis. Younger age and less severe preoperative hormonal deficit predicted normalization of the thyroid and male reproductive axes (p < 0.05). cONcluSiONS After NFA resection, endocrine normalization rates in this study varied with the horm...

Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas

“…Larger tumor size has long been known to increase the likelihood of hormone dysfunction in a variety of sellar pathologies. [11][12][13]19 In this study, larger tumors were indeed significantly associated with preoperative endocrine dysfunction on bivariate analysis. On multivariable analysis, controlling for patient age and sex, this association was not maintained.…”

“…12,14,27 In this study, the most common deficits were indeed hypothyroidism and male hypogonadism, affecting almost 50% of included males, similar to prior studies. 4,7,10,13,19,27 The rates of female hypogonadism were consider-ably lower. 7,13 As previously shown, patient demographics were associated with endocrine status, with older, male patients having a higher likelihood of preoperative endocrine deficits.…”

“…4,7,10,13,19,27 The rates of female hypogonadism were consider-ably lower. 7,13 As previously shown, patient demographics were associated with endocrine status, with older, male patients having a higher likelihood of preoperative endocrine deficits. 13,19 In the postoperative period, the absence of endocrine recovery suggests possible ischemic necrosis to at least some cell populations that may preclude clinically significant recovery of the affected axis.…”

“…Two previously published studies have reported the relationship between gland volume and endocrine recovery up to 1 year following resection of NFPAs, showing variable results. 6,13 Both studies included a heterogeneous cohort of patients treated by either a microscopic or endoscopic transsphenoidal approach, and included patients treated for a recurrence following surgery or radiosurgery. Cho et al 6 specifically included both NFPAs and secretory adenomas, and defined endocrine dysfunction only by the requirement of hormone replacement therapy (HRT), regardless of serum hormone levels.…”

Pituitary non-functioning macroadenomas: If and when to recommend surgery

“…Re-surgery selective or not, or even trans-frontal approach must be taken into consideration in case of post-operatory persistent disease (14,15). Radiotherapy may stop tumour growth but it is better to be delayed in young patients because of the risk of central hypogonadism (16). The index of proliferation value Ki67 was of 2% in the first case and this might explain the relative high rate of growth which is rather unusual for a typical pituitary tumour.…”