Predicting hormonal deterioration following transsphenoidal surgery for non-functioning pituitary adenomas: A systematic review and meta-analysis.

IF 3.3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2026-08-01 DOI:10.1007/s12020-026-04712-6

Daniel Ameen, Youssef ElSabban, Dimitrios Kalaitzoglou, Jonathan Shapey, Sinan Barazi, Nicholas Thomas, Simon Aylwin, Eleni Maratos

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引用次数: 0

Abstract

Background: Endoscopic transsphenoidal surgery is indicated when non-functioning pituitary adenomas (NFPAs) cause visual compromise, but its timing is less certain in patients with preserved vision and intact pituitary function, where the risk of new post-operative pituitary dysfunction influences decision-making. This systematic review aimed to determine the rate of new post-operative endocrine deficits following transsphenoidal surgery for NFPAs and to identify predictive factors.

Methods: This review followed PRISMA guidelines. Studies reporting predictors of post-operative endocrine deterioration in adults undergoing transsphenoidal surgery for NFPAs were included. Predictors were synthesised narratively, with meta-analysis where at least two studies used comparable definitions. Pooled proportions estimated the overall rate of deterioration. Certainty of evidence was assessed using GRADE.

Results: Eleven studies comprising 2,350 patients were included. The pooled proportion developing new post-operative endocrine deterioration was 16% (95% CI 13-20%; I² = 60%). Larger tumour volume was associated with deterioration, and gross total resection with reduced odds compared with subtotal resection. Cavernous sinus invasion and other predictors showed inconsistent associations, while age, sex, comorbidities, apoplexy, pituitary gland or stalk visibility, surgeon experience and surgical approach were not associated with risk. Overall certainty of evidence was low to very low.

Conclusion: New post-operative endocrine deficits affect approximately one in six patients after transsphenoidal surgery for NFPAs. Tumour volume was the most consistent predictor of endocrine deterioration, suggesting a potential role for earlier intervention in selected patients, although evidence certainty was low to very low. Standardised reporting and prospective studies are needed to guide risk stratification decision-making.

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预测无功能垂体腺瘤经蝶窦手术后激素恶化：系统回顾和荟萃分析。

背景：当无功能垂体腺瘤（nfpa）导致视力损害时，内镜下经蝶窦手术是必要的，但在视力保留和垂体功能完整的患者中，手术时机不太确定，术后新发垂体功能障碍的风险影响决策。本系统综述旨在确定nfpa经蝶窦手术后新发术后内分泌缺陷的发生率，并确定预测因素。方法：本综述遵循PRISMA指南。研究报告了经蝶窦手术治疗nfpa的成人术后内分泌恶化的预测因素。预测因子以叙述性的方式综合，并进行荟萃分析，其中至少有两项研究使用了可比较的定义。汇总比例估计了总体恶化率。使用GRADE评估证据的确定性。结果：纳入11项研究，包括2350例患者。术后发生新的内分泌恶化的合并比例为16% （95% CI 13-20%; I²= 60%）。较大的肿瘤体积与恶化有关，与次全切除相比，大体全切除的几率降低。海绵窦侵犯和其他预测因素的相关性不一致，而年龄、性别、合合症、中风、垂体或垂体柄可见性、外科医生经验和手术方式与风险无关。证据的总体确定性从低到极低。结论：大约六分之一的nfpa患者在经蝶窦手术后出现新的术后内分泌缺陷。肿瘤体积是内分泌恶化的最一致的预测指标，这表明在选定的患者中早期干预的潜在作用，尽管证据确定性很低到非常低。需要标准化的报告和前瞻性研究来指导风险分层决策。

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

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.