Department of Neurosurgery, Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal Foundation Trust (SRFT), Stott Lane, Salford, M6 8HD, UK.
Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Acta Neurochir (Wien). 2020 Oct;162(10):2371-2379. doi: 10.1007/s00701-020-04440-4. Epub 2020 Jun 6.
Pre-/postoperative pituitary endocrine deficiencies in patients with sellar/parasellar non-adenomatous lesions are poorly described and studies have not considered the effect of sellar invasion on endocrine outcome. The aim of this study was to relate the need for pituitary hormone replacement pre-/postoperatively, with sellar invasion, in non-adenomatous sellar/parasellar lesions.
Single-centre review of adults with histologically confirmed non-adenomatous sellar/parasellar lesion and follow-up ≥ 3 months or until postop radiotherapy. Pituitary dysfunction was defined by hormone replacement. The sellar encroachment score (0-6) was calculated as the sum of the thirds of radiological encroachment into the sellar region in the coronal and sagittal planes. Multivariate analysis with binary logistic regression was used to determine factors associated with pituitary hormone replacement.
One hundred and seventeen patients were included with a median age of 49 years (range 16-84 years) and median follow-up of 13 months. Surgery was trans-sphenoidal (53%), trans-cranial (36%) or a combination (11%). The commonest histology types were meningioma (n = 33, 28%) and craniopharyngioma (n = 20, 17%). The median sellar encroachment score was 6 (range 0-6). Most (n = 86, 74%) did not require pituitary hormone replacement preoperatively. The need for pituitary hormones increased after surgery in 41 (35%) patients. In multivariate analysis, the sellar encroachment score was the only factor predictive of pre- (OR = 2.6, 95% CI = 1.2-5.5; p = 0.01) and postoperative risk of new pituitary hormone replacement (OR = 4.1, 95% CI = 1.7-10.1, p = 0.002).
A significant proportion of these patients present with need for pituitary hormone replacement that may worsen postoperatively. The degree of sellar encroachment is predictive of pituitary hormone replacement status pre-/postoperatively.
鞍区/鞍旁非腺瘤性病变患者存在术前/术后垂体内分泌功能减退，但相关报道较少，且这些研究并未考虑鞍区侵袭对内分泌结局的影响。本研究旨在探讨非腺瘤性鞍区/鞍旁病变患者的术前/术后垂体激素替代需求与鞍区侵袭之间的关系。
对经组织学证实的鞍区/鞍旁非腺瘤性病变且随访时间≥3 个月或直至术后放疗的成年患者进行单中心回顾性研究。垂体功能减退定义为需要激素替代治疗。采用冠状位和矢状位影像学评估鞍区侵犯程度，将侵犯鞍区的程度分为 0-6 分（6 个 1/3 等分），计算鞍区侵犯评分。采用二元逻辑回归分析多变量分析来确定与垂体激素替代相关的因素。
共纳入 117 例患者，年龄中位数为 49 岁（16-84 岁），中位随访时间为 13 个月。手术方式包括经蝶窦（53%）、经颅（36%）或联合（11%）。最常见的组织学类型为脑膜瘤（n=33，28%）和颅咽管瘤（n=20，17%）。鞍区侵犯评分中位数为 6 分（0-6 分）。大多数患者（n=86，74%）术前无需垂体激素替代治疗。术后 41 例（35%）患者需要新的垂体激素替代治疗。多变量分析显示，鞍区侵犯评分是预测术前（OR=2.6，95%CI=1.2-5.5；p=0.01）和术后新发垂体激素替代风险的唯一因素（OR=4.1，95%CI=1.7-10.1，p=0.002）。
这些患者中有相当一部分存在垂体激素替代需求，且可能在术后加重。鞍区侵犯程度可预测术前/术后垂体激素替代状态。
