Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes

B Alromhain,S M Orme,P Nix,A Sheikh,K Seejore,R D Murray,S M Pearson,S A Alavi,T Wilson,A Tyagi,J M W Robins,N Phillips

doi:10.1186/s12902-021-00777-8

Abstract

BackgroundTranssphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown.MethodsData from patients who underwent endoscopic TSS for a NFPMA (2009–2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes.ResultsOf 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004).ConclusionPre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth.

Highlights

Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA)
Subjects We performed a retrospective analysis of consecutive adult patients who underwent endoscopic transsphenoidal resection for non-functioning pituitary adenoma between 01 July 2009 and 31 August 2018 at Leeds Teaching Hospitals NHS Trust (LTHT)
No significant differences in the age distribution of patients according to gender were found

Summary

Introduction

Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). Non-functioning pituitary adenomas (NFPA) are benign tumours that constitute around one-third of all pituitary neoplasms, have a prevalence of 7–22 cases per 100,000 population [1, 2] and a standardized incidence rate of 1.02–1.08/100,000 [3, 4]. As they do not cause pituitary hormonal hypersecretion syndromes, the diagnosis is either made incidentally during radiological imaging for other indications or when they are large enough to exert pressure effects to surrounding tissues, resulting in headaches and / or visual defects from optic chiasm compression [5]. The treatment of choice in patients with non-functioning pituitary macroadenomas (NFPMA) is transsphenoidal surgery (TSS), aiming for preservation or restoration of vision and long-term tumour control. Hypopituitarism prevails in a considerable portion of patients following surgery and is expected to worsen if adjuvant pituitary radiotherapy is required

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