SEARCHCOHORTendocrinology, neurology

cohort·endocrinology, neurology, surgery, neuro-ophthalmology, observational study·PMC10293445

The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas

Endocrine · 12 authors, 6 centres

AI SUMMARY

FIDELITY 100%

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

“

TL;DR

This retrospective cohort study evaluated pituitary function before and after transsphenoidal surgery in 137 patients with non-functioning pituitary macroadenomas. The central finding was that recovery of pre-existing pituitary deficiencies (46% for at least one axis) was more common than the development of new deficiencies (10%) after surgery.

Full summary

916 CHARS

This retrospective study analyzed 137 patients who underwent transsphenoidal surgery for non-functioning pituitary macroadenomas between 2004 and 2018. The primary aim was to assess changes in pituitary function per hormonal axis. Preoperatively, 67% of patients had at least one deficient axis. Postoperatively, recovery of at least one deficient axis occurred in 46% of patients, while new deficiencies in at least one axis developed in 10%. The recovery rate was highest for growth hormone deficiency (45.5%) and lowest for adrenal insufficiency (15.4% with simplified criteria). The rate of new deficiency was lowest for the TSH axis (1.6%) and highest for the ACTH axis (9.2%). Predictive factors for recovery included male sex and preoperative hyperprolactinemia. No factors were identified for new deficiencies. The findings suggest surgery can offer a net benefit for pituitary function in selected patients.

STUDY TYPE

cohort

SPECIALTY

endocrinology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10293445

The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas

Endocrine

READ THE FULL PAPER

ABSTRACT

Purpose Transsphenoidal surgery for non-functioning pituitary adenomas (NFPAs) can alter pituitary function. We assessed the rates of improvement and deterioration of pituitary function by axis and searched for predictive factors of these outcomes. Methods We reviewed consecutive medical files from patients having had transsphenoidal surgery for NFPA between 2004 and 2018. Pituitary functions and MRI imaging were analyzed prior and after surgery. The occurrence of recovery and new deficit were documented per axis. Prognostic factors of hormonal recovery and new deficits were searched. Results Among 137 patients analyzed, median tumor size of the NFPA was 24.8 mm and 58.4% of patients presented visual impairment. Before surgery, 91 patients (67%) had at least one abnormal pituitary axis (hypogonadism: 62.4%; hypothyroidism: 41%, adrenal insufficiency: 30.8%, growth hormone deficiency: 29.9%; increased prolactin: 50.8%). Following surgery, the recovery rate of pituitary deficiency of one axis or more was 46% and the rate of new pituitary deficiency was 10%. Rates of LH-FSH, TSH, ACTH and GH deficiency recovery were 35.7%, 30.4%, 15.4%, and 45.5% respectively. Rates of new LH-FSH, TSH, ACTH and GH deficiencies were 8.3%, 1.6%, 9.2% and 5.1% respectively. Altogether, 24.6% of patients had a global pituitary function improvement and only 7% had pituitary function worsening after surgery. Male patients and patients with hyperprolactinemia upon diagnosis were more likely to experience pituitary function recovery. No prognostic factors for the risk of new deficiencies were identified. Conclusion In a real-life cohort of patients with NFPAs, recovery of hypopituitarism after surgery is more frequent than the occurrence of new deficiencies. Hence, hypopituitarism could be considered a relative indication for surgery in patients with NFPAs.

CITATION EXPORT

Maria Mavromati, Thomas Mavrakanas, François R. Jornayvaz et al.. The impact of transsphenoidal surgery on pituitary function in patients with non-functioning macroadenomas. Endocrine. (2023). https://doi.org/10.1007/s12020-023-03400-z

AUTHORS

12 · 6 CENTRES

Maria Mavromati, Thomas Mavrakanas, François R. Jornayvaz, Karl Schaller, Aikaterini Fitsiori, Maria I. Vargas, Johannes A. Lobrinus, Doron Merkler, Kristof Egervari, Jacques Philippe, Sophie Leboulleux, Shahan Momjian

1grid.150338.c0000 0001 0721 9812Service of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, WHO Collaborating Center, Geneva University Hospital, Geneva University, Geneva, Switzerland
2grid.14709.3b0000 0004 1936 8649Division of Nephrology, McGill University Health Center, McGill University, Montreal, QC Canada
3grid.150338.c0000 0001 0721 9812Service of Neurosurgery, Geneva University Hospital, Geneva University, Geneva, Switzerland
4grid.150338.c0000 0001 0721 9812Service of Neurodiagnostic, Division of Neuroradiology, Geneva University Hospital, Geneva University, Geneva, Switzerland
5grid.150338.c0000 0001 0721 9812Service of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
6grid.8591.50000 0001 2322 4988Geneva University, Geneva, Switzerland