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Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery

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Abstract

Purpose

Non-functioning pituitary adenomas (NFPAs) are often associated with hyperprolactinemia, which is known as the “stalk effect”. However, the relationships between hyperprolactinemia and the radiographic characteristics of the tumor that affects the pituitary stalk have not been well characterized. We aimed to identify the differences in the clinical and radiographic characteristics of patients with NFPA, with and without hyperprolactinemia.

Methods

We enrolled 107 patients with NFPA and allocated them to hyperprolactinemia and non-hyperprolactinemia groups using two different cut-off values: (1) the upper limit of the normal reference range, adjusted for sex and menopausal status, and (2) the upper quartile across the cohort, and compared their clinical and radiographic characteristics. These analyses were conducted to clarify the relationship between the “stalk effect” and the postoperative change in antidiuretic hormone secretion.

Results

The specific radiographic characteristics of the patients included the presence of a cystic or hemorrhagic tumor and the presence of pituitary stalk deviation, which were more frequent in the patients with hyperprolactinemia. Interestingly, the incidence of postoperative transient diabetes insipidus was statistically significantly higher in the hyperprolactinemia group (≥40 ng/mL) and in the group with radiologic evidence of stalk deviation, which were shown to be independent risk factors on multivariate analysis.

Conclusion

The presence of a “stalk effect” was associated with a higher risk of postoperative transient diabetes insipidus, reflecting perioperative pituitary stalk dysfunction following NFPA surgery, especially in patients with serum prolactin concentrations ≥40 ng/mL and radiologic evidence of stalk deviation.

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Acknowledgements

We would like to thank the nursing, ENT, and anesthesiology teams for perioperative management of the patients undergoing endoscopic endonasal pituitary surgery. We also thank Mark Cleasby, PhD from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Author contributions

Conceptualization: K.S. and A.H., Methodology: K.S., N.T., A.N., and K.A., Formal analysis and investigation: A.H., and K.O., Writing – original draft preparation: K.S., Writing – review and editing: K.A. and M.M., Supervision: M.N. and M.M., All authors have read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan

    Kiyohiko Sakata, Aya Hashimoto, Nobuyuki Takeshige, Kimihiko Orito & Motohiro Morioka

  2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan

    Ayako Nagayama, Kenji Ashida & Masatoshi Nomura

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  1. Kiyohiko Sakata
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Correspondence to Kiyohiko Sakata.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not report animal studies. This study was approved by the ethics committee of the Kurume University School of Medicine (approval number: 18019).

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All the participants concurred with the proposed treatment plan after all the options for the management of non-functioning pituitary adenomas and prolactinomas had been clearly explained. Informed consent was obtained from all the participants in the study.

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Sakata, K., Hashimoto, A., Takeshige, N. et al. Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery. Endocrine (2024). https://doi.org/10.1007/s12020-024-03835-y

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