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Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas

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Abstract

Objectives

Nonfunctionning pituitary macroadenomas (NFPMA) are benign tumors that cause symptoms of mass effects including hypopituitarism. Their primary treatment is transsphenoidal surgery. We aimed to determine the outcome of pituitary hormone deficits after surgical treatment of NFPMA and to identify factors predicting hormonal recovery.

Design

We retrospectively included 246 patients with NFPMA diagnosed and operated in one of the two participating centers. All hormonal axes were evaluated except growth hormone (GH). Postoperative improvement of pituitary endocrine function was considered if at least one hormonal deficit had recovered and a lower total number of deficits was observed 1 year after surgery.

Results

80% (n = 197) of patients had one or more pituitary deficits and 28% had complete anterior hypopituitarism. Besides GH, the gonadotropic and thyrotropic axes were the most commonly affected (68% and 62%, respectively). The number of hypopituitary patients dropped significantly to 61% at 1 year (p < 0.001) and a significant improvement was observed for all hormonal axes, except central diabetes insipidus. Among patients with preoperative hypopituitarism, 88/175 (50%) showed improved pituitary function at 1 year. Both hyperprolactinemia at diagnosis and a lower tumor diameter independently predicted favorable endocrine outcome.

Conclusions

Hypopituitarism is present in 80% of patients with NFPMA and nearly half of them will benefit from sustained improvement after surgery. Hyperprolactinaemia at diagnosis and lower tumor dimensions are associated with favorable endocrine prognosis. This supports the option of early surgery in NFPMA patients with pituitary deficits independent of the presence of visual disturbances.

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Data availability

Data and code for statistical analyses are available upon request.

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Acknowledgements

We thank Dr. Sylvie Salenave for her help in the collection of data.

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Authors and Affiliations

  1. Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Orsalia Alexopoulou, Valérie Everard & Dominique Maiter

  2. Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Le Kremlin-Bicêtre, France

    Martine Etoa & Philippe Chanson

  3. Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

    Edward Fomekong & Christian Raftopoulos

  4. Service de Neurochirurgie, Hopital Foch, Suresnes, France

    Stéphane Gaillard

  5. Assistance Publique-Hôpitaux de Paris, Service de Neurochirurgie, Hopital Bicêtre, Le Kremlin-Bicêtre, France

    Fabrice Parker

  6. Inserm, Physiologie et Physiopathologie Endocriniennes, Université Paris-Saclay, Le Kremlin- Bicêtre, France

    Philippe Chanson

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  1. Orsalia Alexopoulou
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Correspondence to Orsalia Alexopoulou.

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Alexopoulou, O., Everard, V., Etoa, M. et al. Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas. Endocrine 73, 166–176 (2021). https://doi.org/10.1007/s12020-021-02701-5

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