Endocrine Abstracts

Background

Surgical resection is indicated in patients with non-functioning pituitary adenomas (NFPA) causing visual defects or tumor growth in proximity to the optic chiasm. The aim of this study was to systematically assess the benefits and harms of pituitary endocrine function after transsphenoidal surgery in patients with NFPAs.

Methods

This study was conducted a systematic review that searched for potentially eligible studies in Pubmed and EMBASE from database inception to Oct 11, 2020. Inclusion criteria were studies reporting on pituitary function before and after transsphenoidal surgery in patients with NFPAs with a minimum follow-up of one month. The pre-specified primary outcomes were the proportion of participants with improved or deteriorated pituitary function after surgery, and Secondary outcomes was assessment of the effect of pituitary surgery on individual axis. This study was registered with PROSPERO (registration number: CRD42020210853).

Findings

Of the 6228 identified record, 17 studies enrolling 2623 participants were included. The proportion of participants with overall improved pituitary function was 45·0 percent (95% CI. 34·1 to 56·4; I² = 91%) while the proportion of participants with overall deterioration of pituitary function was 10·8 percent (95% CI. 6·6 to 17·2; I² = 92%) after surgery. Subgroup analysis suggested a positive association between year of publication and risk of pituitary failure. The most likely hormonal axis to recover after surgery was the adrenal axis.

Interpretation

The mean proportion of patients with pituitary recovery after transsphenoidal surgery was between 34 and 56% across studies, while the proportion of patients with new pituitary failure after surgery was between 7 and 17% across studies. These estimates were associated with large heterogeneity, which was not explained by subgroup analysis. However, the effect estimates did include important clinical effects and pituitary surgery for recovery of endocrine function may be considered in selected cases.

Funding

There was no funding source for this study.