Pituitary hormonal loss and recovery after transsphenoidal adenoma removal.
OBJECTIVE
Transsphenoidal adenomectomy carries the possibility of new pituitary failure and recovery. Herein, we present rates and determinants of postoperative hormonal status.


METHODS
All consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 8-year period were analyzed. Those with previous sellar radiotherapy were excluded. Pre- and postoperative hormonal status (at least 3 mo after surgery) were determined and correlated with clinical parameters using a multivariate statistical model.


RESULTS
Of 444 patients (median age 45 years, 75% macroadenoma, 19% with multiple operations), 9 had preoperative panhypopituitarism. Of the remaining 435 patients, new hypopituitarism occurred in 5.5% of patients (anterior loss in 5%; permanent diabetes insipidus in 2.1%; including 2 patients who had total hypophysectomy). Of 346 patients with preoperative hormonal dysfunction, 170 (49%) had improved function. "Stalk compression" hyperprolactinemia resolved in 73% of 133 patients; recovery of at least 1 other anterior axis (excluding isolated hypogonadism associated with "stalk compression" hyperprolactinemia) occurred in 24% of 209 patients. Multivariate analysis showed that new hypopituitarism was most strongly associated with larger tumor diameter (P = 0.04). Of 223 patients with an endocrine-inactive adenoma, new hypopituitarism was seen in 0, 7.2, and 13.6% of patients with tumor diameters of <20, 20 to 29, and >or=30 mm, respectively (P = 0.005). Multivariate analysis revealed that resolution of hypopituitarism was related to younger age (39 versus 52 years, P < 0.0001), absence of an intraoperative cerebrospinal fluid leak and, in patients with an endocrine-inactive adenoma, absence of systemic hypertension (24% versus 6%, P = 0.009).


CONCLUSIONS
After transsphenoidal adenomectomy, new unplanned hypopituitarism occurs in approximately 5% of patients, whereas improved hormonal function occurs in 50% of patients. The likelihood of new hormonal loss or recovery appears to depend on several factors. New hypopituitarism occurs most commonly in patients with tumors larger than 20 mm in size, whereas hormonal recovery is most likely to occur in younger, nonhypertensive patients and those without an intraoperative cerebrospinal fluid leak.
Fatemi
Nasrin
N
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90404, USA.
Dusick
Joshua R
JR
Mattozo
Carlos
C
McArthur
David L
DL
Cohan
Pejman
P
Boscardin
John
J
Wang
Christina
C
Swerdloff
Ronald S
RS
Kelly
Daniel F
DF
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010907:Pituitary Hormones / Q000097:blood*; D010911:Pituitary Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D010907:Pituitary Hormones