Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.
World Neurosurg. 2019 Jun;126:e1183-e1189. doi: 10.1016/j.wneu.2019.03.062. Epub 2019 Mar 14.
To investigate the clinical characteristics of hypopituitarism and its reversibility after surgery for nonfunctional pituitary adenoma (NFPA); analyze the correlation between tumor size and hypopituitarism incidence; and predict hypopituitarism by tumor volume and maximum diameter.
We retrospectively reviewed 164 patients with NFPA who underwent surgical treatment at Peking Union Medical College Hospital from January 2016 to December 2016. Demographic, imaging, and endocrine data were collected during preoperative, postoperative, and long-term follow-up (21.1 ± 3.3 months) periods. Differences in hormone levels were analyzed by paired and independent samples t-tests. The cut-off values of tumor size and volume to predict hypopituitarism were calculated by receiver operating characteristic curves.
In total, 80.4% (132/164) of patients had anterior pituitary hypofunction and 48.4% patients had hypogonadism; the recovery rate of luteinizing hormone was 80.9%, and follicular-stimulating hormone was 60%. In total, 36.5% of patients had hypothyroidism; the recovery rate of thyroxine was 85%, free thyroxine was 87.8%, and thyroid-stimulating hormone was 100.0%. Finally, 27.4% of patients had insulin-like growth factor 1 (IGF-1)/growth hormone (GH) hypofunction, and the recovery rate of IGF-1 was 77.8%. The preoperative free thyroxine, thyroxine, GH, IGF-1, follicular-stimulating hormone, and luteinizing hormone levels were significantly lower in the giant adenoma group (n = 43) than in the large adenoma group (n = 121). The hypopituitarism predictive cut-off value of tumor volume was 3105.1 mm and that of tumor diameter was 23.5 mm.
NFPA has a significant influence on gonadal hormone, IGF-1/GH, and thyroid hormone. NFPA can cause single- or multiple-hormone reduction in each pituitary target gland. Tumor size is positively correlated with the incidence and degree of hypopituitarism. NFPA-induced hypopituitarism is significantly recovered after surgical treatment.
研究无功能性垂体腺瘤（NFPA）患者术后垂体功能减退的临床特征及其可逆性；分析肿瘤大小与垂体功能减退发生率的相关性；并通过肿瘤体积和最大直径预测垂体功能减退。
回顾性分析 2016 年 1 月至 2016 年 12 月在我院接受手术治疗的 164 例 NFPA 患者的临床资料。收集患者术前、术后及长期随访（21.1±3.3 个月）的人口统计学、影像学和内分泌数据。采用配对样本 t 检验分析激素水平的差异。通过受试者工作特征曲线计算肿瘤大小和体积的截断值来预测垂体功能减退。
共有 80.4%（132/164）的患者存在腺垂体功能减退，48.4%的患者存在性腺功能减退；促黄体生成素的恢复率为 80.9%，促卵泡生成素为 60%。共有 36.5%的患者存在甲状腺功能减退；甲状腺素的恢复率为 85%，游离甲状腺素为 87.8%，促甲状腺激素为 100.0%。最后，27.4%的患者存在胰岛素样生长因子 1（IGF-1）/生长激素（GH）功能减退，IGF-1 的恢复率为 77.8%。巨腺瘤组（n=43）患者的术前游离甲状腺素、甲状腺素、GH、IGF-1、促卵泡生成素和促黄体生成素水平明显低于大腺瘤组（n=121）。肿瘤体积的预测截点值为 3105.1mm，肿瘤直径的预测截点值为 23.5mm。
NFPA 对性腺激素、IGF-1/GH 和甲状腺激素有显著影响。NFPA 可导致各垂体靶腺发生单激素或多激素减少。肿瘤大小与垂体功能减退的发生率和严重程度呈正相关。NFPA 引起的垂体功能减退在手术后可显著恢复。
