Journal List > J Korean Endocr Soc > v.24(3) > 1003497

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Lee, Han, Kim, Hwang, Chung, Kim, Cho, Rim, and Kim: Pituitary Hormonal Changes after Transsphenoidal Tumor Removal in Non-Functioning Pituitary Adenoma
Original Article
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2009; 24(3): 181-188.

Published online: 30 September 2009

DOI: https://doi.org/10.3803/jkes.2009.24.3.181

Pituitary Hormonal Changes after Transsphenoidal Tumor Removal in Non-Functioning Pituitary Adenoma

Min-Suk Lee, Seung Jin Han, Eun Kyung Kim, Joo An Hwang, Yoon-Sok Chung, Se Hyuk Kim1, Kyung Gi Cho1, Nae-Jung Rim2, Ho Sung Kim2

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Korea.

1Department of Neurosurgery, Ajou University School of Medicine, Korea.

2Department of Diagnostic Radiology, Ajou University School of Medicine, Korea.

Received 9 June 2009       Accepted 27 July 2009

Copyright © 2009 Korean Endocrine Society

Abstract

Background

The present study investigated the rates and the potential predictors of either new pituitary loss or recovery of hormonal function after transsphenoidal removal of a non-functioning pituitary adenoma.

Methods

Patients who underwent transsphenoidal removal of a non-functioning pituitary adenoma from January 2003 to December 2007 at Ajou University Medical Center were included in this retrospective analysis. Patients were excluded if they had a history of previous pituitary tumor surgery, or did not have preoperative pituitary hormonal data.

Results

Of 42 patients included in the analysis, 36 patients had hypopituitarism, 21 patients had "stalk compression" hyperprolactinemia, and 2 patients had normal pituitary function. At long term follow-up (longer than 6 months), 13 patients showed postoperative pituitary hormonal recovery in at least 1 hormonal axis, while 6 patients had developed postoperative hormonal loss in at least 1 hormonal axis. On analysis, neither preoperative serum prolactin level nor tumor size was related to postoperative pituitary hormonal changes.

Conclusion

More than 1/3 of patients who underwent transsphenoidal surgery showed postoperative pituitary hormonal recovery.

Keywords: non-functioning pituitary adenoma, pituitary hormone, pituitary surgery, postoperative outcome

Figures and Tables

Table 1
Staging system for assessment of anatomic relationship of pituitary tumors with their surrounding structures
jkes-24-181-i001
Table 2
Tumor characteristics
jkes-24-181-i002

*Volume = π / 6 × (height × width × length)

Table 3
Preoperative hormonal loss
jkes-24-181-i003
Table 4
Postoperative hormonal changes
jkes-24-181-i004

*The number of patients reported for each hormonal axis only includes patients who had the potential for recovery or loss of function in that particular axis.

Table 5
Predictors of new pituitary hormonal loss: short-term follow-up
jkes-24-181-i005
Table 6
Predictors of recovery of hypopituitarism: short-term follow-up
jkes-24-181-i006
Table 7
Predictors of new pituitary hormonal loss: long-term follow-up
jkes-24-181-i007
Table 8
Predictors of recovery of hypopituitarism: long-term follow-up
jkes-24-181-i008

References

1. Molitch ME. Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin North Am. 2008. 37:151–171.
2. Dekkers OM, Pereira AM, Romijn JA. Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab. 2008. 93:3717–3726.
3. Webb SM, Rigla M, Wägner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999. 84:3696–3700.
4. Alameda C, Lucas T, Pineda E, Brito M, Uria JG, Magallón R, Estrada J, Magallón B. Experience in management of 51 non-functioning pituitary adenomas: indications for post-operative radiotherapy. J Endocrinol Invest. 2005. 28:18–22.
5. Dekkers OM, Pereira AM, Roelfsema F, Voormolen JH, Neelis KJ, Schroijen MA, Smit JW, Romijn JA. Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab. 2006. 91:1796–1801.
6. Harris PE, Afshar F, Coates P, Doniach I, Wass JA, Besser GM, Grossman A. The effects of transsphenoidal surgery on endocrine function and visual fields in patients with functionless pituitary tumours. Q J Med. 1989. 71:417–427.
7. van den Bergh AC, van den Berg G, Schoorl MA, Sluiter WJ, van der Vliet AM, Hoving EW, Szabó BG, Langendijk JA, Wolffenbuttel BH, Dullaart RP. Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma: beneficial effect on local control without additional negative impact on pituitary function and life expectancy. Int J Radiat Oncol Biol Phys. 2007. 67:863–869.
8. Sarlis NJ, Gourgiotis L, Koch CA, Skarulis MC, Brucker-Davis F, Doppman JL, Oldfield EH, Patronas NJ. MR imaging features of thyrotropin-secreting pituitary adenomas at initial presentation. AJR Am J Roentgenol. 2003. 181:577–582.
9. Abosch A, Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J Clin Endocrinol Metab. 1998. 83:3411–3418.
10. Arafah BM. Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab. 1986. 62:1173–1179.
11. Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg. 2002. 97:293–298.
12. Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J. The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer. 1991. 68:860–866.
13. Nomikos P, Ladar C, Fahlbusch R, Buchfelder M. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas -- a study on 721 patients. Acta Neurochir (Wien). 2004. 146:27–35.
14. Auer LM, Clarici G. The first 100 transsphenoidally operated pituitary adenomas in a non-specialised centre: surgical results and tumour-recurrence. Neurol Res. 1985. 7:153–160.
15. Black PM, Zervas NT, Candia GL. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery. 1987. 20:920–924.
16. De P, Rees DA, Davies N, John R, Neal J, Mills RG, Vafidis J, Davies JS, Scanlon MF. Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. J Clin Endocrinol Metab. 2003. 88:3567–3572.
17. Hammer GD, Tyrrell JB, Lamborn KR, Applebury CB, Hannegan ET, Bell S, Rahl R, Lu A, Wilson CB. Transsphenoidal microsurgery for Cushing's disease: initial outcome and long-term results. J Clin Endocrinol Metab. 2004. 89:6348–6357.
18. Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf). 1999. 50:431–439.
19. Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005. 103:448–454.
20. Colao A, Cerbone G, Cappabianca P, Ferone D, Alfieri A, Di Salle F, Faggiano A, Merola B, de Divitiis E, Lombardi G. Effect of surgery and radiotherapy on visual and endocrine function in nonfunctioning pituitary adenomas. J Endocrinol Invest. 1998. 21:284–290.
21. Arafah BM, Nekl KE, Gold RS, Selman WR. Dynamics of prolactin secretion in patients with hypopituitarism and pituitary macroadenomas. J Clin Endocrinol Metab. 1995. 80:3507–3512.
22. Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR. Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab. 1994. 79:348–354.
23. Marazuela M, Astigarraga B, Vicente A, Estrada J, Cuerda C, Garcia-Uria J, Lucas T. Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas. J Endocrinol Invest. 1994. 17:703–707.
24. Fatemi N, Dusick JR, Mattozo C, McArthur DL, Cohan P, Boscardin J, Wang C, Swerdloff RS, Kelly DF. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008. 63:709–718.
25. Park HK, Jun JS, Kim HK, Shin CS, Park KS, Kim SY, Cho BY, Lee HG, Koh CS. Korean Endocrine Society Annual Meeting Abstracts. 1996. In : 15th Annual Meeting: Pituitary hormonal changes after removal of non-functioning macroadenoma; Suppl 1. –51.
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