Pituitary最新文献

{"title":"Correction to: Consensus and Controversies about Diagnosing GH deficiency - A Delphi Survey by the GH Research Society.","authors":"S Radovick, M C Arlien-Søborg, M C S Boguszewski, M Bidlingmaier, G Johannsson, A Grimberg, K K Y Ho, B M K Biller, C S Choong, A R Hoffman, P Backeljauw, C L Boguszewski, J Bollerslev, T Brue, P Chanson, E Christ, S Cianfarani, P E Clayton, P Cohen, A Dauber, M Fleseriu, J Gebauer, A Giustina, C E Higham, R Horikawa, C Höybye, A Juul, M Lodish, X Luo, N Mauras, K K Miller, S Melmed, S J C M M Neggers, N Karavitaki, R Rosenfeld, R Ross, L Savendahl, K Schilbach, P F Collett-Solberg, C J Strasburger, N A Tritos, H M van Santen, K C J van Santen, J O L Jorgensen","doi":"10.1007/s11102-026-01681-x","DOIUrl":"10.1007/s11102-026-01681-x","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply to the Comment on Osteometabolic complications in patients with secreting pituitary adenomas: Is there an impact of gender?","authors":"Andrea Giustina, Luigi di Filippo","doi":"10.1007/s11102-026-01736-z","DOIUrl":"10.1007/s11102-026-01736-z","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative predictors of biochemical remission in acromegaly: a predictive modeling study.","authors":"Hanyao Sun, Biren Patel, Samir Lohana, Rajashree Sarkar, Mario Chiapponi, Ruggero Antonini, Leonardo Tariciotti, J Manuel Revuelta Barbero, Nyrene Haque, Edoardo Porto, Alejandra Rodas, Tomas Garzon-Muvdi, C Arturo Solares, Gustavo Pradilla","doi":"10.1007/s11102-026-01725-2","DOIUrl":"10.1007/s11102-026-01725-2","url":null,"abstract":"<p><strong>Purpose: </strong>Biochemical remission after transsphenoidal resection for acromegaly remains challenging, and early prognostication is limited. This study applies statistical and predictive modeling approaches to identify perioperative predictors of remission.</p><p><strong>Methods: </strong>We retrospectively analyzed 86 patients with acromegaly who underwent endoscopic endonasal transsphenoidal resection of GH-secreting primary pituitary adenomas between January 2018 and January 2025. Preoperative demographic, biochemical, radiologic, and histopathologic variables were evaluated. Patients were randomly split into training and test sets. Missing data were addressed using median and KNN imputation. Five machine learning models (GBM, RF, GLMNET, KNN, and Nnet) were trained using exhaustive feature subset selection and evaluated using AUROC and accuracy.</p><p><strong>Results: </strong>Of 86 patients, 62 (72.1%) achieved biochemical remission. Remission was associated with older age (p = 0.016), round tumor shape (p < 0.0001), gross total resection (p < 0.0001), lower Knosp grade (p < 0.0001), and dense CAM 5.2 staining (p = 0.037). The best-performing model was RF using four features (gender, tumor shape, extent of resection, CAM 5.2), achieving an accuracy of 0.8235 and AUROC of 0.8542 on the test set.</p><p><strong>Conclusion: </strong>Predictive modeling may help estimate biochemical remission after surgery for acromegaly. This exploratory perioperative framework may support postoperative risk stratification and patient counseling while complementing standard endocrine follow-up. Further external validation in larger cohorts is warranted.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex Vivo drug sensitivity in patient-derived 3D cultures in acromegaly and its association with clinical predictors.","authors":"Yasutaka Tsujimoto, Atsushi Ishida, Frederico Gaia Costa da Silva, Hiroki Shichi, Naoko Imagawa, Naoki Yamamoto, Yuma Motomura, Yuka Oi-Yo, Yuriko Sasaki, Masaki Suzuki, Shin Urai, Hironori Bando, Masaaki Yamamoto, Michiko Takahashi, Genzo Iguchi, Maki Kanzawa, Takashi Aoi, Shozo Yamada, Hidenori Fukuoka","doi":"10.1007/s11102-026-01735-0","DOIUrl":"10.1007/s11102-026-01735-0","url":null,"abstract":"<p><strong>Purpose: </strong>Personalized therapy in acromegaly is limited by interindividual variability in drug responses and the lack of robust markers predicting tumor shrinkage, rather than biochemical control alone. To test whether ex vivo drug-induced viability changes in patient-derived 3D cultures (Pd3D) of GH-secreting pituitary adenomas reflect tumor cell-intrinsic pharmacological sensitivity and align with established clinical predictors.</p><p><strong>Methods: </strong>Spheroid-based Pd3D cultures were established from 27 patients with acromegaly. Cultures were exposed to octreotide, cabergoline, pasireotide, or vehicle control. We assessed cell viability changes; sample-level responder status (viability reduction vs vehicle, p < 0.05); and associations between responder status and known predictive markers, including clinical characteristics, MRI findings, dynamic drug tests, and pathological features. In 6 cases, AI-based digital image analysis quantified pre- and post-treatment SSTR2 expression in liquid-based cytology (LBC).</p><p><strong>Results: </strong>All agents modestly reduced median cell viability (84-86%, p < 0.05), with responder rates of 33-40%. Concordance with established predictors was observed: octreotide responders correlated with T2 hypointensity (88% vs 44%, p = 0.04); cabergoline with positive bromocriptine tests (100% vs 45%, p = 0.03); and pasireotide with sparsely granulated patterns (64% vs 19%, p = 0.04). AI-based dynamic analysis demonstrated that ex vivo responders showed relatively stable SSTR2 expression after treatment, whereas nonresponders exhibited marked depletion.</p><p><strong>Conclusion: </strong>Spheroid-based Pd3D ex vivo viability assays revealed modest but significant cohort-level effects and sample-level concordance with clinical predictors, suggesting its potential utility as an exploratory model. Additionally, AI-based quantification of SSTR2 dynamics captured functional receptor shifts.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased impulsivity and higher odds of compulsive shopping among cabergoline-treated patients with prolactinoma: a case-control study.","authors":"Karla Borges Daniel, Andrea Glezer, Nara Lima de Queiroz, Silvia Regina Correa-Silva, Marília Bortolotto Felippe Trentin, Mariana Tazima Fujiwara, Cristina Laguna Benetti-Pinto, Leandro Kasuki, Leonardo Andrade Gontijo Tavares, Pedro Weslley Souza do Rosário, Heraldo Mendes Garmes","doi":"10.1007/s11102-026-01728-z","DOIUrl":"10.1007/s11102-026-01728-z","url":null,"abstract":"<p><p>Dopamine agonists, particularly cabergoline, are the first-line treatment for prolactinomas, but have been associated with impulse control disorders (ICDs). However, data on impulsivity and related behaviors in this population remain limited and inconsistent.</p><p><strong>Objective: </strong>To evaluate impulsivity and ICDs in patients with prolactinoma treated with cabergoline and to compare these findings with healthy controls.</p><p><strong>Methods: </strong>This case-control study included 131 patients with prolactinoma receiving cabergoline and 131 healthy controls. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), and ICDs were evaluated using specific questionnaires addressing hypersexuality, gambling, compulsive shopping, and punding. Multivariable analyses were performed to assess independent associations.</p><p><strong>Results: </strong>Patients treated with cabergoline exhibited higher overall impulsivity, reflected by increased BIS-11 scores and a higher proportion of individuals with increased impulsivity (BIS-11 ≥ 60). Attentional impulsivity remained significantly higher in patients after multivariable adjustment. Patients also had more than fourfold higher odds of compulsive shopping compared with controls, whereas no significant differences were observed for other ICDs. Lower educational level was also associated with higher impulsivity across all BIS-11 domains and with compulsive shopping.</p><p><strong>Conclusion: </strong>Patients with prolactinoma treated with cabergoline exhibit increased impulsivity, particularly in the attentional domain, along with higher odds of compulsive shopping. These results highlight the role of dopaminergic modulation and the influence of sociodemographic factors, supporting the importance of actively assessing impulsivity during clinical follow-up.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom severity and exacerbation frequency in medically treated patients with acromegaly.","authors":"Eliza B Geer, David R Clemmons, Jill Sisco, Maxwell Koobatian, Janetricks C Okeyo, Tiffany P Quock, Yang Wang, Raffaella Colzani, Alan Krasner","doi":"10.1007/s11102-026-01732-3","DOIUrl":"10.1007/s11102-026-01732-3","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify the severity, frequency of symptom exacerbations, and associated life impact of acromegaly symptoms in patients treated with injected depot somatostatin receptor ligands (SRLs).</p><p><strong>Methods: </strong>Patients receiving depot SRLs completed daily 24-hour recall surveys for 3 months. The daily surveys assessed the severity of 7 core symptoms and 2 additional symptoms on numeric scales (0-10). Symptom exacerbation was defined as a ≥ 2-point increase in any symptom score, comparing the current 2-day average with the prior 2-day average. Patients completed a final survey assessing 3-month recall of symptom severity and daily functioning, treatment satisfaction, and healthcare resource utilization (HCRU).</p><p><strong>Results: </strong>The analysis population included 31 patients: mean (SD) age was 53.4 (13.6) years; 24 (77.4%) were female; 15 (48.4%) were receiving SRL monotherapy and 16 (51.6%) SRL plus non-SRL therapy. Three-month recall overestimated symptom severity relative to daily ratings and did not capture exacerbation frequency. Symptom exacerbations assessed via daily surveys occurred, on average, on 32.1% of days (> 2 days/week) throughout the injection cycle. Greater total and individual symptom severity and exacerbation frequency were related to greater life interference, including impaired daily activities, reduced work productivity, reduced treatment satisfaction, diminished life satisfaction, and increased HCRU.</p><p><strong>Conclusion: </strong>In patients with acromegaly treated with injected depot SRLs, symptom exacerbations occurred frequently. Symptom severity and exacerbation frequency were associated with impaired daily functioning and reduced life satisfaction. A simple daily symptom assessment provides clinically meaningful information about adequacy of disease control that is not captured by longer-term recall.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GH Stimulation testing is unnecessary in patients with hypothalamic-pituitary disease, preserved pituitary function, and IGF-I SDS ≥ 0.","authors":"Valentina Gasco, Daniela Cuboni, Michela Sibilla, Francesca Mocellini, Alice Martinotti, Davide Lucisano, Ezio Ghigo, Gianluca Aimaretti, Silvia Grottoli, Mauro Maccario","doi":"10.1007/s11102-026-01697-3","DOIUrl":"10.1007/s11102-026-01697-3","url":null,"abstract":"<p><strong>Purpose: </strong>In adults with hypothalamic-pituitary disease, the presence of at least three additional pituitary hormone deficiencies, with or without markedly reduced IGF-I levels, is considered diagnostic of growth hormone deficiency (GHD) without the need for stimulation testing. In all other cases, dynamic testing is required despite its well-recognized limitations. To date, no formal strategy has been proposed to exclude GHD without performing stimulation tests. This study aims to develop a probabilistic model to estimate the likelihood of GHD in adults with hypothalamic-pituitary disease but no additional pituitary hormone deficiencies, based on IGF-I standard deviation scores (SDS).</p><p><strong>Methods: </strong>We combined literature-derived data on: (1) the probability of an impaired GH response to stimulation tests in patients with hypothalamic-pituitary disease and preserved anterior pituitary function; and (2) the probability that adults with isolated GHD present IGF-I SDS values ≥ 0, ≥ 0.5, or ≥ 1. A Bayesian approach was applied to estimate the post-test probability of GHD in patients meeting these criteria.</p><p><strong>Result: </strong>Across all models, the estimated probability of adult-onset GHD ranged from 6.5% to 19.8%, while the probability of childhood-onset GHD ranged from 2.9% to 9.1%, consistently remaining below 20%, regardless of the IGF-I SDS cut-off applied.</p><p><strong>Conclusion: </strong>In adults with hypothalamic-pituitary disease but no additional hormonal deficiencies, IGF-I SDS values ≥ 0 identify a subgroup with a low, clinically acceptable probability of GHD, in whom stimulation testing may reasonably be avoided. This proof-of-concept model supports a simplified, probability-based diagnostic approach.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disentangling secretory ambiguity and the limitations of classical thresholds in defining prolactinomas.","authors":"Maya Harary, Mishek Thapa, Stuart D Harper, Ines Donangelo, Anthony P Heaney, Won Kim, Marvin Bergsneider","doi":"10.1007/s11102-026-01710-9","DOIUrl":"10.1007/s11102-026-01710-9","url":null,"abstract":"<p><strong>Purpose: </strong>Differentiating prolactinomas from non-functional pituitary adenomas (NFPAs) with stalk effect relies on biochemical thresholds that assume a linear relationship between tumor size and prolactin secretion. We applied a pathology-informed Prolactin Secretory Efficiency (PSE) framework to characterize diagnostic overlap between prolactinomas and NFPAs and evaluate the limitations of current prolactin thresholds.</p><p><strong>Methods: </strong>Retrospective study of 425 patients undergoing first-time surgery for pituitary adenomas: 115 pathology-confirmed lactotroph adenomas, 291 NFPAs, and 19 mammosomatotrophs. Patients with clinical or biochemical evidence of ACTH- or GH-secreting tumors were excluded. PSE was calculated as the serum prolactin-to-tumor volume ratio [Formula: see text]). Primary outcomes included PSE-based group separation and diagnostic accuracy of the 200 ng/mL threshold.</p><p><strong>Results: </strong>While no NFPA exceeded 200 ng/mL, 42% of pathology-confirmed macroprolactinomas and 49% of macro-NFPAs fell within the diagnostic grey zone (ULN < prolactin < 200 ng/mL). PSE achieved superior group separation versus raw prolactin, yet a paradox emerged: high-efficiency stalk effect in some NFPAs produced PSE values exceeding those of low-efficiency macroprolactinomas.</p><p><strong>Conclusions: </strong>Rigid biochemical thresholds fail to capture the full spectrum of lactotroph adenoma biology. Significant secretory ambiguity exists for macroadenomas below 200 ng/mL, creating risk of misclassification. D2-agonist trials may serve as a low-risk diagnostic probe in this grey zone, ensuring low-efficiency prolactinomas receive appropriate first-line medical management.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced breakthrough symptom exacerbations in patients with biochemically controlled acromegaly switched from injected depot somatostatin receptor ligands to once-daily oral paltusotine in the PATHFNDR-1 clinical trial.","authors":"David R Clemmons, Tiffany P Quock, Alessandra Casagrande, Yang Wang, Alan Krasner","doi":"10.1007/s11102-026-01733-2","DOIUrl":"10.1007/s11102-026-01733-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the hypothesis that breakthrough acromegaly symptom exacerbation frequency would be reduced after switching biochemically controlled patients from depot somatostatin receptor ligand (SRL) injections to once-daily oral paltusotine.</p><p><strong>Methods: </strong>Biochemical disease control (insulin-like growth factor 1 [IGF-I]) and Acromegaly Symptom Diary (ASD) data were analyzed from PATHFNDR-1, a 36-week, randomized, placebo-controlled, double-blind, phase 3 trial of paltusotine in patients with acromegaly biochemically controlled (IGF-I ≤ 1.0× ULN) with SRLs. The ASD measured the daily severity of 7 core and 2 exploratory acromegaly symptoms, each rated on a scale from 0 to 10 based on 24-hour recall. Breakthrough acromegaly symptom exacerbations were defined as ≥ 2-point increases for any individual symptom score, comparing a 2-day average with the prior 2-day average.</p><p><strong>Results: </strong>Despite no significant changes in IGF-I levels or overall core symptom severity scores, mean (SE) symptom exacerbation frequencies declined progressively after switching to paltusotine, from 30.2% (5.6%) of days during screening (SRL treatment) to 6.2% (1.6%) of days (n = 22, p < 0.0001). The reduction in individual symptom exacerbation frequencies with paltusotine treatment was consistent across all acromegaly symptoms assessed. IGF-I levels did not correlate significantly with symptom severity scores or symptom variability.</p><p><strong>Conclusion: </strong>In patients with acromegaly biochemically controlled with injected SRLs, switching to once-daily oral paltusotine was associated with stable biochemical control, stable symptom severity, and a significantly reduced frequency of symptom exacerbations. A simple daily symptom assessment tool provided important information pertaining to acromegaly disease control that was not apparent from IGF-I measurements.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of new endocrinological deficits after intraoperative MRI-guided additional resection in endoscopic non-functioning pituitary adenoma surgery.","authors":"Stefanos Voglis, Meltem Gönel, Maria Triantafyllidou, Victor Staartjes, Gianluca Mosca, Jacopo Bellomo, Benjamin Beyersdorf, Kevin Akeret, Bas van Niftrik, Michael Hugelshofer, Bettina Winzeler, Zoran Erlic, Luca Regli, Carlo Serra","doi":"10.1007/s11102-026-01727-0","DOIUrl":"10.1007/s11102-026-01727-0","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative magnetic resonance imaging (ioMRI) has been increasingly used in transsphenoidal surgery for pituitary adenomas to improve the rate of gross total resection (GTR). However, its influence on postoperative pituitary function-particularly the risk of new endocrinological deficits (EDs) due to an additional resection-has not been investigated in detail. This study aimed to evaluate the endocrinological outcomes of ioMRI-guided TSS in patients with nonfunctioning pituitary adenomas (NFPAs), with a focus on the risk of new EDs following ioMRI-guided additional resection.</p><p><strong>Methods: </strong>We performed a retrospective cohort analysis of prospectively collected data from 312 patients who underwent endoscopic transsphenoidal surgery with the \"chopsticks\" technique between July 2013 and July 2022. Of these, 155 patients met the inclusion criteria: histologically confirmed NFPA phenotype and 3-Tesla ioMRI usage. All patients had at least 3 months of endocrinological and MRI follow-up. Hormonal outcomes were reviewed by a dedicated endocrinologist using clinical and biochemical assessments.</p><p><strong>Results: </strong>Among the 155 included patients (median age 60 years; 59% male), the ioMRI GTR rate was 35%; this increased to 65% (n = 98) on 3‑month postoperative MRI as a result of ioMRI‑guided additional resection. Overall, additional resection following ioMRI was performed in 46% (n = 71) of cases. New EDs of at least one pituitary axis were observed in 23% (n = 35) of patients at discharge, 25% (n = 38) at first follow-up (6 weeks postoperatively), and 18% (n = 28) at final follow-up in total. Any recovery of preoperative EDs occurred in 9.7%, 31% and 45% respectively. Uni- and multivariate logistic regression analysis showed that neither GTR, tumor volume, residual tumor volume nor additional resection following ioMRI were associated with increased risk of new deficits.</p><p><strong>Conclusions: </strong>IoMRI-guided additional resection during TSS for NFPAs can be performed safely without increasing the risk of new EDs. These findings support the utility of ioMRI in maximizing the extent of resection while preserving pituitary function.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}