Neurosurgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046, Spain.
Endocrinology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, 28046, Spain.
Endocrine. 2021 Aug;73(2):416-423. doi: 10.1007/s12020-021-02726-w. Epub 2021 Apr 20.
To investigate endocrine function changes after non-functioning pituitary adenomas (NFPA) transsphenoidal surgery and to search for predictors of hypopituitarism resolution and development.
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.
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.
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.
研究无功能垂体腺瘤（NFPA）经蝶窦手术后内分泌功能的变化，并寻找预测垂体功能减退症缓解和发展的指标。
我们纳入了 2005 年至 2019 年间由两位神经外科医生通过内镜经蝶窦手术治疗的 117 例 NFPA 患者。由于先前的垂体手术或放疗，有 21 例患者被排除在外。我们评估了诊断时的症状、肿瘤体积、肿瘤切除、诊断时的激素状态、术后 2 个月和 12 个月的激素结果以及并发症。我们纳入了垂体柄和腺体 MRI 的状态（可见或不可见），并首次研究了它们与激素功能的关系，据我们所知。
在 12 个月时受影响的轴数较少的患者中，垂体腺体的可视化更为频繁（p=0.011）。垂体柄的状态与激素功能无关。术后 12 个月激素正常化率为 13%。术后 12 个月内分泌改善率为 16.7%。19.8%的患者出现激素功能恶化。年龄较小与激素改善相关（p=0.004）。较高的术前肿瘤体积（p=0.015）和非完全肿瘤切除术（GTR）（p=0.049）与术后至少一个激素轴的恶化相关。
在术后激素结果较好的患者中，垂体腺体的可视化程度更高。对初始激素功能和术后垂体柄状态的评估显示无明显相关性。较高的术前肿瘤体积和非 GTR 与术后内分泌功能恶化相关，而年龄较小与改善相关。
