Endocrine Abstracts

Hypopituitarism due to pituitary lesions may have unclear clinical manifestations, and for its diagnosis it is necessary to conduct a hormonal examination. There are clinical recommendations to conduct a hormonal investigation in all cases of pituitary tumors > 6 mm that seems to be uncertain.

The objective to evaluate the frequency of hypopituitarism in patients with pituitary macroadenomas with different hormonal activity and to identify its possible prognostic factors.

The materials and methods: We have analyzed medical records of 293 newly diagnosed patients with pituitary macroadenomas before any treatment: 121 non-functioning adenomas (NFAs), 59 prolactinomas, 113 somatotropinomas. Median patients’ age was 59 [50;64.5] y.o., 32 [27;48.5] y.o. and 53 [41;60] y.o., accordingly.

The results: The hypopituitarism was diagnosed in 59/148 (39.9%) NFAs, in 18/66 (27.3%) prolactinomas and 19/136 (14%) somatotropinomas (р<0.001). The proportion of men with hypopituitarism was higher in NFAs but not in prolactinomas and somatotropinomas. The relative risk (RR) of hypopituitarism in male patients with NFAs was 1.575 (95% confidence interval (CI) 1.212–2.047, P=0.001). MR-signs of chiasm compression, as well as the presence of chiasmal syndrome, were significantly more common in patients with hypopituitarism compared to patients without hypopituitarism in all subgroups. The RR of hypopituitarism in patients with MR-signs of chiasm compression was for NFAs 2.10 (95% CI 1.50 – 2.95, р=0.003), for prolactinomas 1.667 (95% CI 1.29 – 2.18 р=0.005), for somatotropinomas 1.45 (95% CI 1.56 – 2.48, р=0.001). The RR of hypopituitarism in patients with chiasmal syndrome was for NFAs 1.66 (95% CI 1.26 – 2.18, р=0.009), for prolactinomas 2.08 (95% CI 1.60 – 2.69, р=0.001), for somatotropinomas 1.97 (95% CI 1.56 – 2.48, р=0.005). The vertical size and volume of tumor were significantly larger in patients with than without hypopituitarism. Vertical tumor size over 22.5 mm (area under the ROC curve (AUC-ROC) 0.7209, sensitivity 55.91% and specificity 73.44%, P<0.001) and tumor volume over 4472 mm3 (AUC ROC 0.7066, sensitivity 62.77% and specificity 70.16%, P<0.001) were statistically significant cut-off points for the presence of hypopituitarism.

The conclusions: Hypopituitarism should be excluded in patients with pituitary macroadenomas in the presence of the following factors: in non-functioning adenomas – male sex; regardless of hormonal activity – signs of chiasm compression, chiasmal syndrome, vertical tumor size more than 22.5 mm, tumor volume more than 4472 mm3.