Hormone outcomes following endoscopic endonasal resection of nonfunctional pituitary adenomas.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Evan D Bander, Abhinav Pandey, Carson Gundlach, Ying Li, Miguel Tusa Lavieri, Paul J Christos, Georgiana Dobri, Theodore H Schwartz
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引用次数: 0

Abstract

Objective: Resection of nonfunctional pituitary adenomas (NFPAs) can precipitate transient, or in some cases, permanent hormone deficits requiring replacement. Predicting the risk of permanent hormone dysfunction and the possibility of improvement postsurgery is crucial for patient counseling. This study analyzed a large cohort of patients with NFPA to assess predictors of postoperative hormone function and to help both surgeons and patients better predict outcomes.

Methods: The authors conducted a retrospective single-institution study on a series of patients treated for NFPAs at Weill Cornell Medicine between 2006 and 2023. Data including demographics, preoperative hormone status, laboratory values, pathological and radiographic tumor characteristics, and postoperative transient and permanent hormone replacement were collected. Multivariable logistic regression analysis was used to identify predictors of hormone deterioration and improvement.

Results: A cohort of 372 patients were included in this study, 56% of whom presented with preoperative hormone deficiency of at least one axis. A total of 79% of patients underwent gross-total or near-total resection. Postoperatively, 178 (48%) required permanent hormone replacement for at least one hormonal axis: thyroid (34%), cortisol (23%), gonadotropin (15%), and antidiuretic hormone (7%). In patients with no preoperative endocrinopathy, 30.8% needed new hormone replacement therapy. Apoplexy and tumor size were strong predictors. If the tumor was < 2 cm, 23.5% needed new hormone replacement, and if the tumor was > 3 cm, 54.5% needed new hormone replacement. On the other hand, 39.5% of patients with a preoperative hormone deficiency did not require any long-term replacement. If the tumor was < 2 cm, 53.3% improved, and if the tumor was > 3 cm, 32.7% improved. Factors significantly associated with permanent hormone replacement and improvement besides tumor size and the presence of preoperative hormone deficiencies included hemorrhage on MRI, age, and sex, but these associated factors differed for each axis.

Conclusions: This study highlights the relatively high but balanced rates of hormone loss and improvement after surgical removal of nonhormone-producing adenomas. The size of the tumor, apoplexy, and the patient's preoperative hormone status are strong predictors of outcome and can be used to estimate hormone function after surgery.

鼻内窥镜下无功能垂体腺瘤切除术后的激素结果。
目的:切除无功能垂体腺瘤(nfpa)可导致短暂的,或在某些情况下,需要替代的永久性激素缺乏。预测永久性激素功能障碍的风险和术后改善的可能性对患者咨询至关重要。本研究分析了一大批NFPA患者,以评估术后激素功能的预测因素,并帮助外科医生和患者更好地预测预后。方法:作者对2006年至2023年期间在威尔康奈尔医学中心接受nfpa治疗的一系列患者进行了回顾性单机构研究。数据包括人口统计学、术前激素状态、实验室值、肿瘤病理和影像学特征、术后短暂和永久性激素替代。采用多变量logistic回归分析确定激素恶化和改善的预测因素。结果:本研究纳入了372例患者,其中56%的患者术前出现至少一个轴的激素缺乏。总共79%的患者接受了全切除或近全切除。术后178例(48%)患者需要至少一种激素轴的永久性激素替代:甲状腺(34%)、皮质醇(23%)、促性腺激素(15%)和抗利尿激素(7%)。术前无内分泌病变的患者中,30.8%需要新的激素替代治疗。中风和肿瘤大小是强有力的预测因子。如果肿瘤< 2cm, 23.5%的人需要新的激素替代,如果肿瘤小于3cm, 54.5%的人需要新的激素替代。另一方面,39.5%术前激素缺乏的患者不需要任何长期替代。肿瘤< 2 cm改善53.3%,肿瘤< 30 cm改善32.7%。除了肿瘤大小和术前激素缺乏外,与永久性激素替代和改善显著相关的因素包括MRI上的出血、年龄和性别,但这些相关因素在每个轴上都有所不同。结论:本研究强调了手术切除非激素产生性腺瘤后相对较高但平衡的激素损失和改善率。肿瘤大小、中风程度和患者术前激素水平是预后的重要预测因素,可用于评估术后激素功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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