Endocrine Abstracts

Introduction: Surgical treatment of pituitary adenomas (PA) may affect hormone situation.

Objective: To evaluate the frequency of hypopituitarism and investigate the potential predictors of worsening or improving pituitary function after PA surgery.

Methods: Retrospective analysis of all PA operated in our hospital between 2001 and 2010.

Results: Eighty patients were included (51.2% women), with a mean age of 55.6 years (S.D. 16.6 years); 71.2% had non functioning PA. 95% were macroadenomas and mean tumor size was 25.8 mm (S.D. 14 mm). Preoperative hormonal status was normal in 45.3%, 18.8% had 1–2 pituitary deficits and 35.9% had ≥3 deficits. After the intervention, pituitary function was improved or no changed in 70.4% of patients (41.8% had a normal function, 20% 1–2 deficits and 38.2% ≥3 deficits). Predictors of hormone impairment: on univariate analysis we found a non significant trend to worsening in macroadenomas, PA with extrasellar extension and patients with postoperative cerebrospinal fluid fistula. In the last 5 years, the percentage of hormone impairment was reduced (44.4 vs 19.2%, P=0.07). Tumor size and invasion were significant and independently associated to TSH, GH and FSH/LH postsurgical deficits. A normal basal pituitary function was the main conditioning of a normal postsurgical pituitary status. The 85.7% of patients with normal postoperative function had a normal preoperative function too (P<0.001).

On multivariate analysis with logistic regression, size, PA functionality and the number of presurgical deficits were predictors of hormone improving. On the other hand, surgery in the first 5 years of the study period was related to hormone impairment.

Conclusions: Tumor size and invasion were the most important predictors of postsurgical hypopituitarism in our series. Smaller lessions, with intrasellar location or with basal pituitary normofunction exhibited the best outcomes. The greatest experience of our neurosurgical team could explain the better results obtained in the last years.