Endoscopic transsphenoidal surgery (ETSS) is a well-established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). Data on the rates of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS and the predictors of endocrine function before and after ETSS are scarce. This study is purposed to analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA.
A retrospective review of 601 consecutive patients who underwent ETSS between 2010 and 2018 at one institution was performed. Recovery or development of new hypopituitarism was analyzed in 209 NFPA patients who underwent ETSS.
Patients with preoperative endocrine deficits (59.8%) in one or more pituitary axes had larger tumor volumes (P = 0.001) than those without preoperative deficits. Recovery of preoperative pituitary deficit occurred in all four axes, with overall mean recovery of 29.7%. The cortisol axis showed the highest recovery whereas the thyroid axis showed the lowest, with 1-year cumulative recovery rates of 44.3% and 6.1%, respectively. Postoperative hypopituitarism occurred overall in 17.2%, most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Axis-specific predictors of post-operative recovery and deficiency were identified.
Dynamic alterations in pituitary hormones were observed in a proportion of patients following ETSS in NFPA patients. Postoperative endocrine vulnerability, recovery, and factors that predicted recovery or loss of endocrine function depended on the hormonal system, necessitating an axis-specific surveillance strategy postoperatively.
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The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.
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This study did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
Conflicts of interest
AHK is a consultant for Monteris Medical and has received research grants from Monteris Medical and Stryker, regarding a clinical outcomes study for a dural substitute, which has no direct relation to this study. JMS is a primary investigator for clinical studies with Chiasma, Corcept, and StrongBridge, none of which has direct relation to this study. CKC is a consultant for Medtronitcs, which has no direct relation to this study. JSS is a consultant for Medtronics, Olympus, Optinose, and a Speaker's Bureau for Optinose, which are not directly related to this study. MRC received funding from 1) IMRIS Inc. for unrestricted educational grant to support an iMRI database and outcomes analysis project, the IMRIS Muliticenter intraoperative MRI Neurosurgery Database (I-MiND), 2) The Head for the Cure Foundation, and 3) Mrs. Carol Rossfeld and The Alex & Alice Aboussie Family Charitable Foundation, which have no direct relation to this study. Other authors declare no conflicts of interest.
Approval was obtained from the ethics committee of Washington University in Saint Louis. The procedures and evaluations used in this study adhere to the tenets of the Declaration of Helsinki.
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Hwang, J.Y., Aum, D.J., Chicoine, M.R. et al. Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery. Pituitary 23, 389–399 (2020). https://doi.org/10.1007/s11102-020-01045-z
- Nonfunctioning pituitary adenomas
- Endoscopic transsphenoidal surgery
- Endoscopic endonasal surgery
- Endocrine status