Endocrine Abstracts

Background: Fertility outcomes following transsphenoidal surgery (TSS) for pituitary adenoma are unclear, meaning decision-making regarding management options and peri-operative patient counselling is challenging.

Objective: To identify the implications of TSS pituitary adenoma resection on the hypothalamic-pituitary-gonadal (HPG) axis and evaluate longer-term fertility outcomes to identify the burden of post-operative infertility.

Design: Retrospective Analysis

Population: The population consisted of 236 patients (females >50y were excluded) diagnosed with a non-functional adenoma (NFA), Cushing’s disease or acromegaly who underwent transsphenoidal pituitary surgery at the University Hospital of Wales (UHW) between 2011-2019.

Method: Retrospective analysis of patients’ electronic records was conducted via Welsh Clinical Portal and Cardiff and Vale Portal.

Results: n = 236. Sex: 173 (73%) male, 63 (27%) female. Mean age: 48(15-81)y male and 35(15-50)y female. Diagnosis: 138 NFA, 31 Cushing’s, 67 acromegaly. Post-operatively – New hypogonadism: 13 (7.5%) males and 1 (1.6%) female. HPG axis restoration: 14 (8.1%) males and 7 (11.1%) females. Fertility – Males: 4/173 (2%) desired fertility, 1 (0.6%) of whom started gonadotrophin therapy; we were unable to determine whether successful conception occured for male patients. Females: 13/63 (20.6%) desired fertility. 6/13 (46.2%) (diagnosis: 2-NFA, 2-Cushing’s, 2-acromegaly) conceived naturally. 7/13 (53.8%) were referred to fertility services. 3/7 declined and 4/7 underwent fertility treatment, resulting in a birth in 1/4 (25%) (Diagnosis: acromegaly) but had failed to be successful in 3/4 (75%) (diagnosis: 1-NFA, 1-Cushing’s, 1-acromegaly) prior to our data collection: 1 of these went on to conceive naturally but miscarried.

Conclusion: A desire for fertility was more commonly expressed by female patients post-TSS in our case series. Around half of females desiring fertility in this retrospective review were able to conceive naturally. Of those referred for fertility treatment, 1/4 had treatment resulting in a live birth. Our analyses are limited by small case numbers and limited duration of follow-up.