Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility

Sbardella, Emilia; Minnetti, Marianna; Pofi, Riccardo; Cozzolino, Alessia; Greco, Ermanno; Gianfrilli, Daniele; Isidori, Andrea M.

doi:10.1159/000508107

Cited by 5 publications

(4 citation statements)

References 129 publications

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“…Galactorrhoea and amenorrhoea were relatively common in females with prolactin-secreting tumours, with a higher incidence of oligo-amenorrhoea in macro-tumours, in agreement with previous studies [13,25,26]. In the Group A, the most frequent pituitary deficiency was the gonadal failure [27], as also reported in non-functioning pituitary tumours [20,28,29]. On the contrary, in non-endocrine lesions, the most frequent deficiencies were CH and CAI.…”

Section: Discussionsupporting

confidence: 90%

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Feola

Pirchio

Puliani

et al. 2022

J Endocrinol Invest

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Background Sellar/parasellar lesions have been studied in the adult and paediatric age range, but during the transition age their epidemiology, clinical manifestations, management and treatment outcomes have been poorly investigated. Materials and methods An Italian multicentre cohort study, in which hospital records of patients with diagnosis of sellar/parasellar lesions during the transition age and young adulthood (15–25 years), were reviewed in terms of prevalence, clinical and hormonal features at diagnosis, and outcomes where available. Both pituitary neuroendocrine tumours (pituitary tumours, Group A) and non-endocrine lesions (Group B) were included. Results Among Group A (n = 170, 46.5% macroadenomas), the most frequent were prolactin and GH-secreting tumours, with a female predominance. Among Group B (n = 28), germinomas and Rathke cells cysts were the most common. In Group A, the most frequent hormonal deficiency was gonadal dysfunction. Galactorrhoea and amenorrhoea were relatively common in female patients with prolactinomas. Pre-surgical diabetes insipidus was only seen in Group B, in which also hormone deficiencies were more frequent and numerous. Larger lesions were more likely to be seen in Group B. Patients in Group B were more frequently male, younger, and leaner than those of Group A, whereas at last follow-up they showed more obesity and dyslipidaemia. In our cohort, the percentage of patients with at least one pituitary deficiency increased slightly after surgery. Conclusions The management of sellar/parasellar lesions is challenging in the transition age, requiring an integrated and multidisciplinary approach. Hormone and metabolic disorders can occur many years after treatment, therefore long-term follow-up is mandatory.

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Section: Discussionsupporting

confidence: 90%

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Feola

Pirchio

Puliani

et al. 2022

J Endocrinol Invest

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“…Pathologically, the parasellar region is mainly affected by pituitary adenomas with extrasellar invasion. Nevertheless, in some 9% of cases, the parasellar region is affected by lesions not derived from the pituitary, such as non‐neoplastic cystic lesions and, more rarely, tumours of the parasellar region 2,5 …”

Section: Introductionmentioning

confidence: 99%

A clinical approach to parasellar lesions in the transition age

Sbardella

Puliani

Feola

et al. 2021

J Neuroendocrinology

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Many reviews have summarised the pathology and management of the parasellar region in adult patients, although an analysis of these aspects in the transition years, from puberty onset to the age of peak bone mass, has been lacking. A comprehensive search of English‐language original articles, published from 2000 to 2020, was conducted in the MEDLINE database (December 2019 to March 2020). We selected all studies regarding epidemiology, diagnosis and management of the following parasellar lesions: germinoma, craniopharyngioma, Langerhans cell histiocytosis, optic glioma, hypothalamic hamartoma, tuber cinereum hamartoma, cranial chordoma, Rathke cleft cyst, hypophysitis and hypothalamitis during the transition age from childhood to adulthood. In the present review, we provide an overview of the principal parasellar lesions occurring in the transition age. Symptoms are usually a result of the mass effect of the lesions on nearby structures, as well as anterior pituitary deficits. Diabetes insipidus occurs frequently in these patients. In this age group, pubertal developmental disorders may be more evident compared to other stages of life. Parasellar lesions in the transition age mostly include neoplastic lesions such as germinomas, hamartomas, optic gliomas, craniopharyngiomas Langerhans cell histiocytosis and chordomas, and rarely inflammatory lesions (hypophysitis, hypothalamitis). There are limited data on the management of parasellar lesions in the transition age. Endocrine evaluation is crucial for identifying conditions that require hormonal treatment so that they can be treated early to improve the quality of life of the individual patient in this complex age range. The clinical approach to parasellar lesions involves a multidisciplinary effort.

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“…Aside from the mass effect-related damage on the healthy pituitary gland, anterior pituitary dysfunction can also derive from iatrogenic injuries involving the sellar region and is generally regarded as one of the most frequent complications of pituitary surgery, occurring in 5–25% of cases [ 29 – 31 ]. Following surgical manipulation, postoperative hormone function largely depends on the state of healthy gland tissue.…”

Section: Discussionmentioning

confidence: 99%

Pituitary adenoma consistency affects postoperative hormone function: a retrospective study

et al. 2023

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Background Tumor consistency recently emerged as a key factor in surgical planning for pituitary adenomas, but its impact on postoperative endocrine function is still unclear. Our study aimed to evaluate the impact of tumor consistency on the development of postoperative pituitary deficiencies. Methods Single-center, retrospective analysis of consecutive pituitary surgeries performed between January 2017 and January 2021 at Policlinico Umberto I in Rome. All patients underwent radiological and biochemical evaluations at baseline, and hormone assessments 3 and 6 months after pituitary surgery. Postoperative MRI studies were used to determine resection rates following surgery. Data on tumor consistency, macroscopic appearance, neurosurgical approach, and intraoperative complications were collected. Results Fifty patients [24 women, mean age 57 ± 13 years, median tumor volume 4800 mm3 [95% CI 620–8828], were included. Greater tumor volume (χ2 = 14.621, p = 0.006) and male sex (χ2 = 12.178, p < 0.001) were associated with worse preoperative endocrine function. All patients underwent transsphenoidal adenomectomy. Fibrous consistency was observed in 10% of patients and was associated with a Ki-67 greater than 3% (χ2 = 8.154, p = 0.04), greater risk of developing postoperative hormone deficiencies (χ2 = 4.485, p = 0.05, OR = 8.571; 95% CI: 0.876–83.908), and lower resection rates (χ2 = 8.148, p = 0.004; OR 1.385, 95% CI; 1.040–1.844). Similarly, worse resection rates were observed in tumors with suprasellar extension (χ2 = 5.048, p = 0.02; OR = 6.000, 95% CI; 1.129–31.880) and CSI (χ2 = 4.000, p = 0.04; OR = 3.857, 95% CI; 0.997–14.916). Conclusions Tumor consistency might provide useful information about postoperative pituitary function, likely due to its impact on surgical procedures. Further prospective studies with larger cohorts are needed to confirm our preliminary findings.

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Late Effects of Parasellar Lesion Treatment: Hypogonadism and Infertility

Cited by 5 publications

References 129 publications

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

Sellar and parasellar lesions in the transition age: a retrospective Italian multi-centre study

A clinical approach to parasellar lesions in the transition age

Pituitary adenoma consistency affects postoperative hormone function: a retrospective study

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