Pre- and postoperative need for pituitary hormone replacement in non-adenomatous sellar and parasellar lesions: importance of the sellar encroachment score

Abstract

Background Pre-/postoperative pituitary endocrine deficiencies in patients with sellar/parasellar non-adenomatous lesions are poorly described and studies have not considered the effect of sellar invasion on endocrine outcome. The aim of this study was to relate the need for pituitary hormone replacement pre-/postoperatively, with sellar invasion, in non-adenomatous sellar/parasellar lesions. Methods Single-centre review of adults with histologically confirmed non-adenomatous sellar/parasellar lesion and follow-up ≥ 3 months or until postop radiotherapy. Pituitary dysfunction was defined by hormone replacement. The sellar encroachment score (0–6) was calculated as the sum of the thirds of radiological encroachment into the sellar region in the coronal and sagittal planes. Multivariate analysis with binary logistic regression was used to determine factors associated with pituitary hormone replacement. Results One hundred and seventeen patients were included with a median age of 49 years (range 16–84 years) and median follow-up of 13 months. Surgery was trans-sphenoidal (53%), trans-cranial (36%) or a combination (11%). The commonest histology types were meningioma (n = 33, 28%) and craniopharyngioma (n = 20, 17%). The median sellar encroachment score was 6 (range 0–6). Most (n = 86, 74%) did not require pituitary hormone replacement preoperatively. The need for pituitary hormones increased after surgery in 41 (35%) patients. In multivariate analysis, the sellar encroachment score was the only factor predictive of pre- (OR = 2.6, 95% CI = 1.2–5.5; p = 0.01) and postoperative risk of new pituitary hormone replacement (OR = 4.1, 95% CI = 1.7–10.1, p = 0.002). Conclusion A significant proportion of these patients present with need for pituitary hormone replacement that may worsen postoperatively. The degree of sellar encroachment is predictive of pituitary hormone replacement status pre-/postoperatively.

Nomograms to Predict Endocrinological Deficiency in Patients With Surgically Treated Craniopharyngioma

“…Particularly, attention must be paid when interpreting our results that pituitary stalk infiltrated by tumors could be sacrificed, as only 15 patients underwent exclusive stalk sacrifice, warranting further investigation. Third, we defined endocrinological deficiency as the need for pituitary hormone replacement rather than objective measurement of pituitary hormone levels, which may underestimate the rate of pituitary deficiency, although it arguably gives a more clinically meaningful result ( 14 ). At last, the injury type of the HPA cannot be quantitatively defined, which may lead to bias when determining injury types between different neurosurgeons.…”

“…The protocol of hormone replacement was determined by the endocrinologist. Anterior pituitary dysfunction during follow-up was defined as replacement hormone required for at least one anterior pituitary hormone axis ( 14 ). For the purpose of our study, we focused on the endocrinological outcomes at 1 year after surgery and permanent DI representing posterior pituitary function was defined as at least 1 year of the need for desmopressin therapy after surgery ( 19 ).…”

“…Univariate and stepwise multivariate logistic regression was used to determine independent risk factors associated with the need for anterior pituitary hormone replacement 1 year after surgery and permanent DI in the training cohort. First, we performed univariate logistic regression analysis using all the clinical variables associated with endocrinological deficiency after CP surgery based on our subject matter knowledge and the established risk factors identified by previous literatures ( 7 , 10 , 14 ). Then, a stepwise multivariate logistic regression analysis was performed using variables with p < 0.1 in the univariate logistic regression analysis.…”

“…Meanwhile, it is well understood that the HPA plays a pivotal role in maintaining pituitary function. However, when evaluating endocrinological outcomes following surgery or addressing the issue that whether the pituitary stalk infiltrated by tumors can be sacrificed to achieve radical resection, previous studies only analyzed the effects of either the injury of the pituitary stalk ( 7 – 11 ) or the injury of the hypothalamus ( 12 , 13 ) or the injury of the pituitary ( 14 ) on pituitary function, not mentioning any information about whether or not the other part of the HPA was injured. Given that the combined injury of the HPA is often encountered in patients with surgically treated CP due to different topographical characteristics of tumors, it is necessary to elucidate the impacts of combined injuries of the HPA on pituitary function, which is very helpful to comprehensively evaluate the impacts of the manipulation of the HPA on pituitary function and further tailor individual surgical strategies.…”