title: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for Pretreatment Endocrine Evaluation of Patients With Nonfunctioning Pituitary Adenomas.
abstract: Nonfunctioning pituitary adenomas (NFPAs) are among the most common pituitary lesions and may present with hypopituitarism and/or hyperprolactinemia.
  
  
  
  To review the existing literature as it pertains to preoperative endocrine assessment in the workup for NFPAs.
  
  
  
  A systematic review methodology was utilized to identify and screen articles assessing the role and results of preoperative laboratory assessment in patients with NFPAs. The prevalence of individual pituitary hormonal axis deficiencies was reviewed.
  
  
  
  Twenty-nine studies met inclusion criteria for analysis. No class I evidence was available, and all studies met criteria for class II evidence. Baseline serum laboratory assessment showed a prevalence of overall hypopituitarism in 37% to 85% of patients. The most common hormonal axis deficiency was growth hormone deficiency, prevalent in 61% to 100% of patients. The next most common deficit was hypogonadism, seen in 36% to 95% of patients. Adrenal insufficiency was diagnosed in 17% to 62% of patients. Finally, hypothyroidism was seen in 8% to 81% of patients. Hyperprolactinemia was seen in 25% to 65% of patients, with a mean level of 39 ng/mL and with a minority of patients exceeding a serum prolactin level of 200 ng/mL. No evidence supporting routine biomarker testing (eg, α-subunit or chromogranin A) or genetic testing in patients with sporadic NFPAs was available.
  
  
  
  Despite a paucity of class I evidence, multiple retrospective studies have demonstrated a high prevalence of hypopituitarism in patients with NFPAs. Routine endocrine analysis of all anterior pituitary axes to assess for hypopituitarism is recommended, with prolactin and insulin-like growth factor 1 evaluation also valuable to assess for hypersecretion states that might not be clinically suspected. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_3.
  
  
  
  GH, growth hormoneIGF-1, insulin-like growth factor 1NFPA, nonfunctioning pituitary adenoma.
authors.affiliation: ‡Departments of Medicine and Neurological Surgery, OHSU Northwest Pituitary Center, Oregon Health Science University, Portland, Oregon; §Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶Barrow Neurological Institute, Phoenix, Arizona; ‖Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, California; #Department of Neurosurgery, Emory University, Atlanta, Georgia; **Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; ‡‡Department of Neurosurgery, George Washington University, Washington, DC; §§Department of Neurosurgery, University of California, San Francisco, San Francisco, California; ¶¶Department of Neurological Surgery, University of Southern California, Los Angeles, California.
authors.forename: Maria
authors.initials: M
authors.lastname: Fleseriu
authors.forename: Mary E
authors.initials: ME
authors.lastname: Bodach
authors.forename: Luis M
authors.initials: LM
authors.lastname: Tumialan
authors.forename: Vivien
authors.initials: V
authors.lastname: Bonert
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
authors.forename: Zachary
authors.initials: Z
authors.lastname: Litvack
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zada
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000601:surgery; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000175:diagnosis* / Q000209:etiology; D007018:Hypopituitarism / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery