Prevalence of pituitary insufficiency in patients with nonfunctioning pituitary macroadenoma and evolution following neurosurgical treatment: a study of 150 patients

Valérie Everard Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Summary :


Non-functioning pituitary macroadenomas (NFPA) are supracentimetric adenomas whose main symptoms (visual impairment, pituitary insufficiency, headaches) are caused by the compression of adjacent anatomical structures. NFPA are mostly treated by transsphenoidal tumor resection in order to correct or avoid symptoms caused by mass effects. Limited data are available regarding the evolution of pituitary functions following surgery.



This work was aimed at determining the evolution of hormonal levels of the anterior pituitary following transsphenoidal surgery of NFPA by comparing hormonal status before surgery and at 3 and 12 months after surgery. We also analyzed the factors predictive of an improvement or worsening of hormonal deficits at 1 year post-surgery.



This was a retrospective study including 150 patients (sex ratio M/F 85/65) with a mean age of 57 years. Among the study population, 64% of patients had visual disturbances and 40% complained about headaches. At least one hormonal insufficiency was found in 81% of patients. Gonadal axis deficiency was slightly more frequent than the other types of insufficiencies. Tumor width was significantly larger and hyperprolactinemia was more frequent in patients with hormonal deficits. A significant decrease (p<0.05) of all anterior pituitary insufficiencies was observed at 3 and 12 months after surgery as compared to before surgery. By contrast, the frequency of diabetes insipidus increased significantly. Multivariate analysis revealed that tumor height, older age, and the presence of a “null cell adenoma” were independent predictors of a negative outcome of pituitary functions after surgery.



We can conclude that transsphenoidal resection of NFPA often leads to an improvement of anterior pituitary functions, whereas the frequency of diabetes insipidus increases. A higher tumor height, an older age, and the presence of a “null cell adenoma” are predictive factors for a less favorable evolution of hormonal deficits.