Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals, Sheffield, UK.
Division of Medicine, University College London, London, UK.
Endocrine. 2023 Oct;82(1):143-151. doi: 10.1007/s12020-023-03434-3. Epub 2023 Jun 30.
Non-functioning pituitary macroadenomas (NFPMs) may present with hypopituitarism. Pituitary surgery and radiotherapy pose an additional risk to pituitary function.
To assess the incidence of hypopituitarism at presentation, the impact of treatment, and the likelihood of endocrine recovery during follow-up.
All patients treated surgically with and without radiotherapy for NFPMs between 1987 and 2018 who had longer than six months follow-up were identified. Demographics, presentation, investigation, treatment, and outcomes were collected.
In total, 383 patients were identified. The median age was 57 years, with a median follow-up of 8 years. Preoperatively, 227 patients (227/375; 61%) had evidence of at least one pituitary deficiency. Anterior panhypopituitarism was more common in men (p = 0.001) and older patients (p = 0.005). Multiple hormone deficiencies were associated with large tumours (p = 0.03). Patients treated with surgery and radiotherapy had a higher incidence of all individual pituitary hormone deficiency, anterior panhypopituitarism, and significantly lower GH, ACTH, and TSH deficiencies free survival probability than those treated with surgery alone. Recovery of central hypogonadism, hypothyroidism, and anterior panhypopituitarism was also less likely to be reported in those treated with surgery and radiotherapy. Those with preoperative hypopituitarism had a higher risk of pituitary impairment at latest review than those presented with normal pituitary function (p = 0.001).
NFPMs are associated with a significant degree of hypopituitarism at time of diagnosis and post-therapy. The combination of surgery and radiotherapy is associated with a higher risk of pituitary dysfunction. Recovery of pituitary hormone deficit may occur after treatment. Patients should have regular ongoing endocrine evaluation post-treatment to assess changes in pituitary function and the need for long-term replacement therapy.
无功能性垂体大腺瘤（NFPM）可能表现为垂体功能减退。垂体手术和放疗会增加垂体功能障碍的风险。
评估首发时垂体功能减退的发生率、治疗的影响以及随访期间内分泌恢复的可能性。
确定了 1987 年至 2018 年间接受手术治疗（包括放疗）和未接受放疗的 NFPM 患者，随访时间超过 6 个月。收集了人口统计学、表现、检查、治疗和结局。
共确定了 383 例患者。中位年龄为 57 岁，中位随访时间为 8 年。术前，227 例（227/375；61%）存在至少一种垂体功能减退的证据。男性（p=0.001）和老年患者（p=0.005）更常见全垂体功能减退。多种激素缺乏与大肿瘤有关（p=0.03）。接受手术和放疗的患者发生所有单个垂体激素缺乏、全垂体功能减退以及 GH、ACTH 和 TSH 缺乏无复发生存率显著低于仅接受手术治疗的患者。接受手术和放疗的患者恢复中枢性性腺功能减退、甲状腺功能减退和全垂体功能减退的可能性也较低。与术前无垂体功能减退的患者相比，术后出现垂体功能障碍的风险更高（p=0.001）。
NFPM 与诊断时和治疗后明显程度的垂体功能减退有关。手术和放疗的联合应用与更高的垂体功能障碍风险相关。治疗后可能会恢复垂体激素缺乏。患者在治疗后应定期进行内分泌评估，以评估垂体功能变化和长期替代治疗的需要。
