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Early hormonal recovery following endoscopic transsphenoidal surgery for silent non-functioning pituitary adenomas with hormone dysfunction

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Abstract

Purpose

The role of transsphenoidal surgery in the recovery of preexisting hormone dysfunction from pituitary tumors remains controversial. This study aimed to investigate the incidence of hormone dysfunction among asymptomatic non-functioning pituitary adenomas and their recovery following endoscopic transsphenoidal surgery.

Methods

Eligibility criteria included age under 80 years, presence of a non-functioning pituitary adenoma compressing the normal gland resulting in deviation of the stalk, absence of visual symptoms, and availability for regular follow-up using MRI and pre- and post-operative endocrinological assessments. 182 patients with silent non-functioning pituitary adenomas were included in this study between March 2014 and December 2018. All patients underwent endoscopic transsphenoidal surgery and complete hormonal evaluation, with basal hormone assays and a combined pituitary function test before and after surgery until the end of last follow-up.

Results

Preoperative assessment of hormonal function revealed that 124 of 182 patients (68.1%) had at least a single hormone dysfunction preoperatively. Among these, 61 of 124 (49.2%) had a dysfunction in a single axis, and 63 (50.8%) had a hormone dysfunction in two or more axes. Overall, the median endocrinological follow-up duration was 15.0 months (6–57 months). At 1 month following surgery, 91 patients (73.4%) with hormone dysfunction experienced improvement in at least a single hormone axis. Prolactin was the most common hormone among those that recovered at the last follow up (92.8% improvement) followed by growth hormone (GH, 50.0%), thyroid stimulating hormone (TSH, 50.0%), gonadotropin (Gn, 46.9%), and adrenocorticotropic hormone (ACTH, 45.0%). Time to recovery varied from 1.1 months (for prolactin) to 2.2 months (for gonadotropin, and ACTH). In patients with preoperative deficiency in GH, and ACTH, postoperative transient diabetes insipidus was associated with poor recovery (GH: HR = 0.50, p = 0.048; ACTH: HR = 0.39, p = 0.023).

Conclusions

Non-functioning pituitary adenomas with silent hormone dysfunction are often overlooked by clinicians and patients. We suggest that even silent hormone dysfunction in patients with non-functioning pituitary adenomas can be improved with effective surgical decompression and these tumors may be potential indications of endoscopic transsphenoidal surgery.

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The manuscript has no mandatory deposition data and will not be deposited.

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

Author information

Author notes

  1. Min Ho Lee and Kyu Yeon Hur Contributed equally to this work

Authors and Affiliations

  1. Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, the Catholic University of Korea, Seoul, Korea

    Min Ho Lee

  2. Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Min Ho Lee, Ho Jun Seol, Jung Won Choi, Jung- Il Lee, Do-Hyun Nam & Doo-Sik Kong

  3. Division of Endocrinology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Kyu Yeon Hur

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Sang Duk Hong

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  1. Min Ho Lee
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Contributions

DSK conceived and designed the study. MHL, and KYH analyzed the data and wrote the manuscript. SDH, HJS, JWC, JIL, and DHN provided and collected data.

Corresponding author

Correspondence to Doo-Sik Kong.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. No funds, grants, or other support was received.

Ethical approval

The study was approved by the appropriate institutional research ethics committee (Samsung Medical Center) and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. As the study is retrospective study, the informed consent was waived by ethics committee.

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Lee, M.H., Hur, K.Y., Hong, S.D. et al. Early hormonal recovery following endoscopic transsphenoidal surgery for silent non-functioning pituitary adenomas with hormone dysfunction. J Neurooncol 153, 343–350 (2021). https://doi.org/10.1007/s11060-021-03774-y

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