Purpose

Nonfunctioning pituitary adenomas (NFPAs) are among the commonest benign tumors of the pituitary. Hypopituitarism is frequently present at the time of diagnosis, and this has been attributed to stalk portal vessel compression and/or destruction of normal anterior pituitary cells. The aim of our study was to examine possible factors at diagnosis associated with the presence of hypopituitarism.

Methods

We retrospectively evaluated the records of patients with nonfunctioning pituitary macroadenomas from the database of our department. The inclusion criterion was the availability of imaging data regarding the extension of the lesion.

Results

A total of 148 patients (89 men, 60.1%) with nonfunctioning macroadenomas and available imaging data were identified. Mean age at diagnosis was 56.0 ± 14.5 years, and hypopituitarism was found in 66.2%. The maximum diameter of the adenoma, the patient’s age at diagnosis, and compression of the optic chiasm were significant factors predicting the presence of hypopituitarism (OR 1.077, p = 0.006; OR 1.025, p = 0.045; and OR 2.893, p = 0.042, respectively). Suprasellar adenomas with extension to adjacent sinuses, although larger than those with only suprasellar extension, did not differ as to the degree of hypopituitarism. Moreover, in suprasellar adenomas, prolactin levels, albeit not independently, were also related to hypopituitarism (OR 1.035, p = 0.045).

Conclusions

In patients with NFPAs, prognostic factors related to increased risk of hypopituitarism are age at diagnosis, size of the adenoma, and most importantly the presence of suprasellar extension. These data accentuate the necessity for surgical decompression in case of suprasellar extension, in order, apart from saving visual acuity, to possibly avoid or reverse hypopituitarism.

中文翻译：

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上鞍上延伸独立预测非功能性垂体大腺瘤患者的术前垂体激素缺乏：单中心经验。

目的

无功能的垂体腺瘤（NFPA）是垂体中最常见的良性肿瘤之一。垂体功能减退症在诊断时经常出现，这归因于柄门脉血管受压和/或正常垂体前叶细胞的破坏。我们研究的目的是检查与垂体功能低下相关的诊断可能的因素。

方法

我们回顾性评估了我科数据库中垂体无功能性垂体腺瘤患者的病历。纳入标准是有关病变范围的影像数据的可用性。

结果

总共确定了148例无功能大腺瘤的患者（89名男性，占60.1％），并且可获得影像学数据。诊断时的平均年龄为56.0±14.5岁，垂体功能低下率为66.2％。腺瘤的最大直径，诊断时的患者年龄以及视交叉的压迫是预测存在垂体功能低下的重要因素（OR 1.077，p  = 0.006； OR 1.025，p  = 0.045； OR 2.893，p  = 0.042，分别）。上颌窦腺瘤延伸至邻近的鼻窦，尽管比仅上鞍窦延展的腺瘤大，但垂体功能低下的程度无差异。此外，在鞍上腺瘤中，催乳素水平（尽管不是独立地）也与垂体功能低下有关（OR 1.035，p = 0.045）。

结论

在患有NFPA的患者中，与垂体功能低下风险增加相关的预后因素是诊断时的年龄，腺瘤的大小，最重要的是存在鞍上延伸。这些数据强调了在鞍状上延伸的情况下进行手术减压的必要性，以便除了节省视力之外，还可能避免或逆转垂体功能低下。