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Suprasellar extension independently predicts preoperative pituitary hormone deficiencies in patients with nonfunctioning pituitary macroadenomas: a single-center experience

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Abstract

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.

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References

  1. Greenman Y, Stern N (2009) Non-functioning pituitary adenomas. Best Pract Res Clin Endocrinol Metab 23(5):625–638. https://doi.org/10.1016/j.beem.2009.05.005

    Article  CAS  PubMed  Google Scholar 

  2. Buurman H, Saeger W (2006) Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol 154(5):753–758. https://doi.org/10.1530/eje.1.02107

    Article  CAS  PubMed  Google Scholar 

  3. Korbonits M, Carlsen E (2009) Recent clinical and pathophysiological advances in non-functioning pituitary adenomas. Horm Res 71(Suppl 2):123–130. https://doi.org/10.1159/000192449

    Article  CAS  PubMed  Google Scholar 

  4. Jaffe CA (2006) Clinically non-functioning pituitary adenoma. Pituitary 9(4):317–321. https://doi.org/10.1007/s11102-006-0412-9

    Article  PubMed  Google Scholar 

  5. Lopes MBS (2017) The 2017 World Health Organization classification of tumors of the pituitary gland: a summary. Acta Neuropathol 134(4):521–535. https://doi.org/10.1007/s00401-017-1769-8

    Article  CAS  PubMed  Google Scholar 

  6. Molitch ME (2008) Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin N Am 37(1):151–171, xi. https://doi.org/10.1016/j.ecl.2007.10.011

    Article  Google Scholar 

  7. Fleseriu M, Bodach ME, Tumialan LM, Bonert V, Oyesiku NM, Patil CG, Litvack Z, Aghi MK, Zada G (2016) Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery 79(4):E527–E529. https://doi.org/10.1227/NEU.0000000000001387

    Article  PubMed  Google Scholar 

  8. Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S, French Endocrinology Society non-functioning pituitary adenoma w-g (2015) Management of clinically non-functioning pituitary adenoma. Ann Endocrinol (Paris) 76(3):239–247. https://doi.org/10.1016/j.ando.2015.04.002

    Article  Google Scholar 

  9. Dekkers OM, Pereira AM, Romijn JA (2008) Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. J Clin Endocrinol Metab 93(10):3717–3726. https://doi.org/10.1210/jc.2008-0643

    Article  CAS  PubMed  Google Scholar 

  10. Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR (2000) The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab 85(5):1789–1793. https://doi.org/10.1210/jcem.85.5.6611

    Article  CAS  PubMed  Google Scholar 

  11. Zayour DH, Selman WR, Arafah BM (2004) Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metab 89(11):5649–5654. https://doi.org/10.1210/jc.2004-0884

    Article  CAS  PubMed  Google Scholar 

  12. Kruse A, Astrup J, Cold GE, Hansen HH (1992) Pressure and blood flow in pituitary adenomas measured during transsphenoidal surgery. Br J Neurosurg 6(4):333–341

    Article  CAS  Google Scholar 

  13. Berkmann S, Fandino J, Muller B, Kothbauer KF, Henzen C, Landolt H (2012) Pituitary surgery: experience from a large network in Central Switzerland. Swiss Med Wkly 142:w13680. https://doi.org/10.4414/smw.2012.13680

    Article  PubMed  Google Scholar 

  14. Fatemi N, Dusick JR, Mattozo C, McArthur DL, Cohan P, Boscardin J, Wang C, Swerdloff RS, Kelly DF (2008) Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery 63(4):709–718; discussion 718-709. https://doi.org/10.1227/01.NEU.0000325725.77132.90

    Article  PubMed  Google Scholar 

  15. Del Monte P, Foppiani L, Ruelle A, Andrioli G, Bandelloni R, Quilici P, Prete C, Palummeri E, Marugo A, Bernasconi D (2007) Clinically non-functioning pituitary macroadenomas in the elderly. Aging Clin Exp Res 19(1):34–40

    Article  Google Scholar 

  16. Nomikos P, Ladar C, Fahlbusch R, Buchfelder M (2004) Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas -- a study on 721 patients. Acta Neurochir 146(1):27–35. https://doi.org/10.1007/s00701-003-0174-3

    Article  CAS  PubMed  Google Scholar 

  17. Drange MR, Fram NR, Herman-Bonert V, Melmed S (2000) Pituitary tumor registry: a novel clinical resource. J Clin Endocrinol Metab 85(1):168–174. https://doi.org/10.1210/jcem.85.1.6309

    Article  CAS  PubMed  Google Scholar 

  18. Webb SM, Rigla M, Wagner A, Oliver B, Bartumeus F (1999) Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab 84(10):3696–3700. https://doi.org/10.1210/jcem.84.10.6019

    Article  CAS  PubMed  Google Scholar 

  19. Jahangiri A, Wagner JR, Han SW, Tran MT, Miller LM, Chen R, Tom MW, Ostling LR, Kunwar S, Blevins L, Aghi MK (2016) Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis. J Neurosurg 124(3):589–595. https://doi.org/10.3171/2015.1.JNS141543

    Article  CAS  PubMed  Google Scholar 

  20. Yuh WT, Fisher DJ, Nguyen HD, Tali ET, Gao F, Simonson TM, Schlechte JA (1994) Sequential MR enhancement pattern in normal pituitary gland and in pituitary adenoma. AJNR Am J Neuroradiol 15(1):101–108

    CAS  PubMed  Google Scholar 

  21. Gorczyca W, Hardy J (1987) Arterial supply of the human anterior pituitary gland. Neurosurgery 20(3):369–378

    Article  CAS  Google Scholar 

  22. Lees PD, Fahlbusch R, Zrinzo A, Pickard JD (1994) Intrasellar pituitary tissue pressure, tumour size and endocrine status--an international comparison in 107 patients. Br J Neurosurg 8(3):313–318

    Article  CAS  Google Scholar 

  23. Lees PD, Pickard JD (1987) Hyperprolactinemia, intrasellar pituitary tissue pressure, and the pituitary stalk compression syndrome. J Neurosurg 67(2):192–196. https://doi.org/10.3171/jns.1987.67.2.0192

    Article  CAS  PubMed  Google Scholar 

  24. Arafah BM (1986) Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 62(6):1173–1179. https://doi.org/10.1210/jcem-62-6-1173

    Article  CAS  PubMed  Google Scholar 

  25. Arafah BM, Nekl KE, Gold RS, Selman WR (1995) Dynamics of prolactin secretion in patients with hypopituitarism and pituitary macroadenomas. J Clin Endocrinol Metab 80(12):3507–3512. https://doi.org/10.1210/jcem.80.12.8530591

    Article  CAS  PubMed  Google Scholar 

  26. Arafah BM, Harrington JF, Madhoun ZT, Selman WR (1990) Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metab 71(2):323–328. https://doi.org/10.1210/jcem-71-2-323

    Article  CAS  PubMed  Google Scholar 

  27. Lammert A, Walter MS, Giordano FA, Al Zhgloul M, Kramer BK, Nittka S, Schulte DM, Ratliff M, Hanggi D, Seiz-Rosenhagen M (2018) Neuro-endocrine recovery after pituitary apoplexy: prolactin as a predictive factor. Exp Clin Endocrinol Diabetes. https://doi.org/10.1055/a-0640-2915

  28. Mukherjee A, Murray RD, Columb B, Gleeson HK, Shalet SM (2003) Acquired prolactin deficiency indicates severe hypopituitarism in patients with disease of the hypothalamic-pituitary axis. Clin Endocrinol 59(6):743–748. https://doi.org/10.1046/j.1365-2265.2003.01916.x

    Article  Google Scholar 

  29. Webb SM, Ruscalleda J, Schwarzstein D, Calaf-Alsina J, Rovira A, Matos G, Puig-Domingo M, de Leiva A (1992) Computerized tomography versus magnetic resonance imaging: a comparative study in hypothalamic-pituitary and parasellar pathology. Clin Endocrinol 36(5):459–465

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology Diabetes and Metabolism, Evangelismos Hospital, 10676, Athens, Greece

    Dimitris Margaritopoulos, Dimitra Argyro Vassiliadi, Maria Markou, Eirini Evangelatou, Marinella Tzanela & Stylianos Tsagarakis

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  1. Dimitris Margaritopoulos
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  2. Dimitra Argyro Vassiliadi
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  3. Maria Markou
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Correspondence to Dimitris Margaritopoulos.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments. The study was approved by the Institutional Review Board of Evangelismos General Hospital of Athens, Greece.

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Margaritopoulos, D., Vassiliadi, D.A., Markou, M. et al. Suprasellar extension independently predicts preoperative pituitary hormone deficiencies in patients with nonfunctioning pituitary macroadenomas: a single-center experience. Hormones 19, 245–251 (2020). https://doi.org/10.1007/s42000-020-00183-0

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