Pituitary function at presentation and following therapy in patients with non-functional pituitary macroadenomas: a single centre retrospective cohort study.
Hypopituitarism
Non-functioning Pituitary Adenoma
Radiotherapy
Transsphenoidal Surgery
Journal
Endocrine
ISSN: 1559-0100
Titre abrégé: Endocrine
Pays: United States
ID NLM: 9434444
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
18
07
2022
accepted:
15
06
2023
medline:
29
8
2023
pubmed:
30
6
2023
entrez:
30
6
2023
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
Non-functioning pituitary macroadenomas (NFPMs) may present with hypopituitarism. Pituitary surgery and radiotherapy pose an additional risk to pituitary function.
OBJECTIVES
To assess the incidence of hypopituitarism at presentation, the impact of treatment, and the likelihood of endocrine recovery during follow-up.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
Identifiants
pubmed: 37389717
doi: 10.1007/s12020-023-03434-3
pii: 10.1007/s12020-023-03434-3
pmc: PMC10462492
doi:
Substances chimiques
Pituitary Hormones
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
143-151Informations de copyright
© 2023. Crown.
Références
J Clin Endocrinol Metab. 2000 Feb;85(2):574-84
pubmed: 10690858
PLoS One. 2016 Jan 29;11(1):e0147575
pubmed: 26824435
Endocr Rev. 1985 Fall;6(4):552-63
pubmed: 2416559
J Clin Endocrinol Metab. 1986 Jun;62(6):1173-9
pubmed: 3009521
Neurosurgery. 2019 Aug 1;85(2):E226-E232
pubmed: 30325449
Cancer. 1991 Aug 15;68(4):860-6
pubmed: 1855185
Clin Endocrinol (Oxf). 2008 Aug;69(2):292-8
pubmed: 18221393
Neurosurgery. 1997 Feb;40(2):225-36; discussion 236-7
pubmed: 9007854
J Neurosurg. 2019 Nov 15;133(6):1732-1738
pubmed: 31731279
Clin Endocrinol (Oxf). 2016 Nov;85(5):748-756
pubmed: 27327840
Lancet. 2003 May 31;361(9372):1881-93
pubmed: 12788587
Endocr J. 1995 Jun;42(3):421-7
pubmed: 7670572
Neuroendocrinology. 2015;102(4):267-273
pubmed: 25924873
Lancet. 1990 Aug 4;336(8710):285-8
pubmed: 1973979
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Endocr Rev. 1998 Apr;19(2):203-23
pubmed: 9570037
J Neurosurg. 2016 Mar;124(3):589-95
pubmed: 26252454
Front Endocrinol (Lausanne). 2013 Mar 18;4:30
pubmed: 23508065
Endocrine. 2016 Oct;54(1):15-23
pubmed: 27481361
Eur J Endocrinol. 2010 May;162(5):853-9
pubmed: 20207728
J Clin Endocrinol Metab. 1995 May;80(5):1577-83
pubmed: 7745003
Eur J Endocrinol. 2006 Dec;155(6):823-9
pubmed: 17132751
J Clin Endocrinol Metab. 1999 Oct;84(10):3696-700
pubmed: 10523016
Ann Clin Biochem. 2009 Sep;46(Pt 5):351-67
pubmed: 19675057
Lancet. 2021 Feb 13;397(10274):613-629
pubmed: 33484633
Pituitary. 2018 Apr;21(2):111-118
pubmed: 29368293
World Neurosurg. 2019 Jun;126:e1183-e1189
pubmed: 30880207
Acta Neurochir (Wien). 2022 Apr;164(4):1135-1144
pubmed: 35079890
Neuroendocrinology. 2012;96(4):333-42
pubmed: 22687984
Pituitary. 2018 Apr;21(2):119-129
pubmed: 29275530
Clin Endocrinol (Oxf). 2017 Oct;87(4):359-366
pubmed: 28502079
J Pediatr Endocrinol Metab. 2005 May;18(5):433-42
pubmed: 15921172
Endocr Dev. 2009;15:1-24
pubmed: 19293601
Int J Endocrinol. 2012;2012:972617
pubmed: 22899919
J Clin Endocrinol Metab. 2016 Nov;101(11):3888-3921
pubmed: 27736313