Evaluation of potential predictors of hypopituitarism after pituitary adenoma surgery

Authors

M.A. Sampedro-Nuñ ez^{1, 2}, R. Martí n-Garcí a², G. Martí n-Á vila², R.G. Centeno³, C.B. Carrerra⁴, C. Á lvarez-Escolá ⁵, A. Vicente⁶, I. Huguet-Moreno¹, A.M. Ramos-Leví ¹, M. Marazuela¹

Affiliations

¹Hospital Universitario La Princesa, Madrid, Spain

²Universidad Autó noma de Madrid, Madrid, Spain

³Hospital Universitario Gregorio Marañ ó n, Madrid, Spain

⁴Hospital Universitario Prí ncipe de Asturias, Alcalá de Henares, Madrid, Spain

⁵Hospital Universitario La Paz, Madrid, Spain

⁶Hospital Virgen de la Salud, Toledo, Spain

Abstract

Introduction. Pituitary adenomas are the most frequent intracranial tumors. Surgical excision is the primary approach for these tumors, except for prolactinomas, and secondary hypopituitarism is its main complication.

Aim: to assess the prevalence of postoperative hypopituitarism and analyze the risk factors involved in its development.

Materials and methods. Ambispective multicenter observational study. Data were collected from The Molecular Registry of Pituitary Adenomas (REMAH). Univariate and multivariate analysis were performed in 128 patients with histologically confirmed adenomas who underwent transsphenoidal surgery between 2009 and 2015 in hospitals from Madrid, with more than one-month follow-up.

Results. Postoperative hypopituitarism was found in 73.9% of cases (28.4% of new onset). Combined pituitary deficiency was the most frequently observed (46.3%), and hypoadrenalism the most frequent single postsurgical deficit (63.7%). Factors significantly associated with postoperative hypopituitarism in the univariate analysis were: previous hypopituitarism, larger tumor diameter, transsphenoidal endoscopic approach and presence of other postoperative complications (p < 0.05). Independent predictors in the multivariate model were: tumor diameter and presurgical hypopituitarism for both single and multiple postsurgical deficits (p < 0.05).

Conclusion. Tumor size and previous hypopituitarism were independent predictors of postoperative hypopituitarism. Endoscopic transsphenoidal surgery was associated to a higher rate of hypopituitarism, and can be reconsidered as a modifiable factor in future studies.

Keywords

hypopituitarism; transsphenoidal surgery; рituitary adenomas

Название

Оценка факторов риска гипопитуитаризма после хирургического лечения аденом гипофиза

Авторы

M.A. Sampedro-Nuñ ez^{1, 2}, R. Martí n-Garcí a², G. Martí n-Á vila², R.G. Centeno³, C.B. Carrerra⁴, C. Á lvarez-Escolá ⁵, A. Vicente⁶, I. Huguet-Moreno¹, A.M. Ramos-Leví ¹, M. Marazuela¹