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Role of pituitary stalk and gland radiological status on endocrine function and outcome after endoscopic transsphenoidal surgery for non-functioning pituitary adenomas

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Abstract

Purpose

To investigate endocrine function changes after non-functioning pituitary adenomas (NFPA) transsphenoidal surgery and to search for predictors of hypopituitarism resolution and development.

Methods

We included 117 patients with NFPA who underwent endoscopic transsphenoidal surgery from 2005 to 2019 by two neurosurgeons. Twenty-one patients were excluded because of previous pituitary surgery or radiotherapy. We assessed symptoms at diagnosis, tumour volume, tumour removal, hormonal status at diagnosis, hormonal outcomes at 2- and 12-month follow-up, and complications. Pituitary stalk and gland MRI status (visible or not) were included, and it theirs association to hormonal function was studied for the first time, to our knowledge.

Results

Pituitary gland visualization was more frequent in those patients who showed a smaller number of axes affected at 12 months (p = 0.011). Pituitary stalk status showed no association to hormonal function. The hormonal normalization rate at 12 months was 13%. The endocrine improvement rate at 12 months was 16.7%. Worsening of hormonal function occurred in 19.8% of patients. Younger age was associated to hormonal improvement (p = 0.004). Higher preoperative tumour volume (p = 0.015) and absence of gross total resection (GTR) (p = 0.049) were associated with worsening in at least one hormonal axis after surgery.

Conclusions

Pituitary gland visibility was higher in those patients who showed better hormonal outcomes. Assessment of initial hormonal function and outcome after surgery regarding pituitary stalk status showed no significant association. Higher preoperative tumour volumes and absence of GTR were associated to postoperative endocrine function worsening, while younger age was associated to its improvement.

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Data availability

All data are available under request.

Abbreviations

NFPA:

non-functioning pituitary adenomas

DI:

diabetes Insipidus

SIADH:

syndrome of inappropriate antidiuretic hormone secretion

MRI:

magnetic resonance imaging

GTR:

gross total resection

GH:

growth hormone

IGF-1:

insulin-like growth factor 1

TSH:

thyroid-stimulating hormone

T4:

thyroxine

ACTH:

adrenocorticotropic hormone

FSH:

follicle-stimulating hormone

LH:

luteinizing hormone

CI:

confidence interval

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Authors and Affiliations

  1. Neurosurgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046, Spain

    C. Vivancos Sánchez, A. Palpán Flores, V. Rodríguez Domínguez, A. Zamarrón Pérez & C. Pérez López

  2. Endocrinology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046, Spain

    C. Álvarez-Escolá

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  1. C. Vivancos Sánchez
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by C.V.S., C.P.L. and A.P.F. The first draft of the manuscript was written by C.V.S. and all authors read and approved the final manuscript.

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Correspondence to C. Vivancos Sánchez.

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The authors declare no competing interests.

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This study has been approved by the institutional Ethics Committee.

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All patients signed the informed consent for participating in the study and publishing images and data under anonymization.

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Vivancos Sánchez, C., Palpán Flores, A., Rodríguez Domínguez, V. et al. Role of pituitary stalk and gland radiological status on endocrine function and outcome after endoscopic transsphenoidal surgery for non-functioning pituitary adenomas. Endocrine 73, 416–423 (2021). https://doi.org/10.1007/s12020-021-02726-w

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