Characteristics and influencing factors of neuroendocrine dysfunction in patients with adult-onset craniopharyngioma.

Objective: The aim of the study was to compare neuroendocrine dysfunction patterns in adult-onset adamantinomatous craniopharyngiomas (ACPs) and papillary craniopharyngiomas (PCPs) before and after surgery, and identify factors that influence neuroendocrine outcomes in these two histopathological types.

Methods: A retrospective analysis was conducted on 390 patients with adult-onset craniopharyngioma (CP) patients, including 272 patients with ACP and 118 patients with PCP. The pre- and post-operative neuroendocrine parameters were compared, and the factors that contributed to poor endocrine outcomes were identified.

Results: Suprasellar tumor extension (83.1% vs. 70.6%, p = 0.01), mass effects (81.4% vs. 68.4%, p<0.01), and pre-operative central diabetes insipidus (CDI; 35.6% vs. 21.0%, p = 0.02) rates were higher in the PCP group, when compared to the ACP group. However, both PCP and ACP patients presented with a post-operative increase in growth hormone deficiency (GHD), CDI, and hypothalamic-pituitary-target dysfunction (p<0.05 vs. pre-operative baselines). Furthermore, the hypothalamic-pituitary-adrenal (HPA) axis dysfunction (75.4% vs. 65.3%, p = 0.04) and GHD (50.0% vs. 34.7%, p<0.01) rates were higher in the ACP group, when compared to the PCP group. Surgical intervention had a greater detrimental effect on overall pituitary function in ACP patients, when compared to PCP patients. The ACP pathological type, larger tumors, and milder pre-operative endocrine dysfunction were associated with a significantly higher risk of postoperative pituitary hormone deficiencies (p<0.05).

Conclusions: Surgical intervention may exacerbate pituitary dysfunction in adult patients with ACP and PCP, although different factors influence the adverse endocrine outcomes for these two pathological types.