title: Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis.
abstract: OBJECTIVE
  The impact of transsphenoidal surgery for nonfunctional pituitary adenomas (NFAs) on preoperative hypopituitarism relative to the incidence of new postoperative endocrine deficits remains unclear. The authors investigated rates of hypopituitarism resolution and development after transsphenoidal surgery.
  
  
  METHODS
  Over a 5-year period, 305 transsphenoidal surgeries for NFAs performed at The California Center for Pituitary Disorders were retrospectively reviewed.
  
  
  RESULTS
  Patients with preoperative endocrine deficits (n = 153, 50%) were significantly older (mean age 60 vs 54 years; p = 0.004), more frequently male (65% vs 44%; p = 0.0005), and had larger adenomas (2.4 cm vs 2.1 cm; p = 0.02) than patients without preoperative deficits (n = 152, 50%). Of patients with preoperative endocrine deficits, 53% exhibited symptoms. Preoperative deficit rates were 26% for the thyroid axis; 20% and 16% for the male and female reproductive axes, respectively; 13% for the adrenocorticotropic hormone (ACTH)/cortisol axis, and 19% for the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis. Laboratory normalization rates 6 weeks and 6 months after surgery without hormone replacement were 26% and 36% for male and 13% and 13% for female reproductive axes, respectively; 30% and 49% for the thyroid axis; 3% and 3% for the cortisol axis; and 9% and 22% for the IGF-1 axis (p < 0.05). New postoperative endocrine deficits occurred in 42 patients (13.7%). Rates of new deficits by axes were: male reproductive 3% (n = 9), female reproductive 1% (n = 4), thyroid axis 3% (n = 10), cortisol axis 6% (n = 19), and GH/IGF-1 axis 4% (n = 12). Patients who failed to exhibit any endocrine normalization had lower preoperative gland volumes than those who did not (0.24 cm(3) vs 0.43 cm(3), respectively; p < 0.05). Multivariate analyses revealed that no variables predicted new postoperative deficits or normalization of the female reproductive, cortisol, and IGF-1 axes. However, increased preoperative gland volume and younger age predicted the chances of a patient with any preoperative deficit experiencing normalization of at least 1 axis. Younger age and less severe preoperative hormonal deficit predicted normalization of the thyroid and male reproductive axes (p < 0.05).
  
  
  CONCLUSIONS
  After NFA resection, endocrine normalization rates in this study varied with the hormonal axis and were greater than the incidence of new endocrine deficits. Low preoperative gland volume precluded recovery. Patient age and the severity of the deficiency influenced the recovery of the thyroid and male reproductive axes, the most commonly impaired axes and most likely to normalize postoperatively. This information can be of use in counseling patients with hypopituitarism who undergo NFA surgery.
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Arman
authors.initials: A
authors.lastname: Jahangiri
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Wagner
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Han
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Mai T
authors.initials: MT
authors.lastname: Tran
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Liane M
authors.initials: LM
authors.lastname: Miller
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Maxwell W
authors.initials: MW
authors.lastname: Tom
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Ostling
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kunwar
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Lewis
authors.initials: L
authors.lastname: Blevins
authors.affiliation: Department of Neurosurgery and The California Center for Pituitary Disorders, University of California, San Francisco, California.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004702:Endocrine Glands / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007006:Hypogonadism / Q000453:epidemiology* / Q000517:prevention & control; D007016:Hypophysectomy; D007018:Hypopituitarism / Q000453:epidemiology* / Q000517:prevention & control; D007037:Hypothyroidism / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
keywords: ACTH = adrenocorticotropic hormone; FSH = follicle-stimulating hormone; GH = growth hormone; GnRH = gonadotropin-releasing hormone; IGF-1= insulin-like growth factor-1; LH = luteinizing hormone; NFA = nonfunctional adenoma; T4 = thyroxine; TRH = thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone; endocrine deficits; hypopituitarism; nonfunctional adenoma; pituitary surgery