Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Endocrinology, Shijiazhuang People's Hospital, The People Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Eur J Endocrinol. 2021 Apr;184(4):617-625. doi: 10.1530/EJE-20-1310.
To investigate the incidence of hypothalamus-pituitary-gonadal (HPG) axis initiation/recovery after treatment and to identify predictive risk factors for noninitiation/recovery.
A total of 127 consecutive suprasellar germ cell tumor (GCT) patients managed at Peking Union Medical College Hospital (2006-2019) were retrospectively analyzed. Prepubertal patients (followed up until 13 years of age for girls and 14 years of age for boys) and patients with HPG dysfunction (followed up for 2 years) were divided into the initiation/recovery and noninitiation/recovery groups.
Of the 127 suprasellar GCT patients, 75 met the follow-up criteria, 28 (37.3%) of whom experienced HPG axis initiation/recovery. Compared to the noninitiation/recovery group, the initiation/recovery group included more males and had shorter delayed diagnosis times, smaller tumor sizes, lower panhypopituitarism rates, thinner pituitary stalk widths, lower visual deficit rates, and higher serum testosterone and estradiol levels. The cutoff values of pituitary stalk width, tumor size, and delayed diagnosis time used to predict noninitiation/recovery were 6.9 mm, 6.9 mm and 1.7 years, respectively. Tumor size ≥6.9 mm (odds ratio (OR) = 7.5, 95% CI: 2.2-25.8, P = 0.001), panhypopituitarism (OR = 5.0, 95% CI: 1.4-17.6, P = 0.013), and delayed diagnosis time ≥1.7 years (OR = 5.7, 95% CI: 1.5-20.7, P = 0.009) were risk factors for noninitiation/recovery.
Among suprasellar GCT patients, nearly one-third of prepubertal patients and patients with HPG dysfunction experience HPG axis initiation/recovery after treatment. Tumor size ≥6.9 mm, panhypopituitarism, and delayed diagnosis time ≥1.7 years were identified as predictive risk factors for noninitiation/recovery.
探讨治疗后下丘脑-垂体-性腺（HPG）轴启动/恢复的发生率，并确定非启动/恢复的预测风险因素。
回顾性分析 2006 年至 2019 年在北京协和医院治疗的 127 例鞍上生殖细胞肿瘤（GCT）连续患者。青春期前患者（随访至女孩 13 岁和男孩 14 岁）和 HPG 功能障碍患者（随访 2 年）分为启动/恢复和非启动/恢复组。
在 127 例鞍上 GCT 患者中，有 75 例符合随访标准，其中 28 例（37.3%）经历了 HPG 轴启动/恢复。与非启动/恢复组相比，启动/恢复组中男性更多，诊断延迟时间更短，肿瘤体积更小，全垂体功能减退发生率更低，垂体柄更细，视觉缺损率更低，血清睾酮和雌二醇水平更高。用于预测非启动/恢复的垂体柄宽度、肿瘤大小和诊断延迟时间的截断值分别为 6.9mm、6.9mm 和 1.7 年。肿瘤大小≥6.9mm（优势比（OR）=7.5，95%置信区间：2.2-25.8，P=0.001）、全垂体功能减退（OR=5.0，95%置信区间：1.4-17.6，P=0.013）和诊断延迟时间≥1.7 年（OR=5.7，95%置信区间：1.5-20.7，P=0.009）是非启动/恢复的危险因素。
在鞍上 GCT 患者中，近三分之一的青春期前患者和 HPG 功能障碍患者在治疗后经历 HPG 轴启动/恢复。肿瘤大小≥6.9mm、全垂体功能减退和诊断延迟时间≥1.7 年被确定为非启动/恢复的预测风险因素。
