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Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas
The Journal of Clinical Endocrinology and Metabolism
|June 1, 1986
Summary
Surgery for large nonfunctioning pituitary adenomas can improve pituitary function. Preoperative tests like TSH response to TRH and normal or elevated prolactin levels predict recovery, especially for smaller tumors.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Large nonfunctioning pituitary adenomas (NFPAs) can cause hypopituitarism through mass effect.
- Assessing pituitary function pre- and post-surgery is crucial for managing these patients.
Purpose of the Study:
- To evaluate pituitary function before and after transsphenoidal adenomectomy in patients with NFPAs.
- To identify predictors of pituitary function recovery after surgery.
Main Methods:
- Detailed pituitary function tests (basal and dynamic) were performed on 26 patients before and after surgery.
- Hormone levels (PRL, GH, TSH, LH, FSH, ACTH) and responses to TRH stimulation were assessed.
- Tumor size was correlated with functional outcomes.
Main Results:
- Preoperatively, all patients had GH deficiency, 96% hypogonadism, 81% hypothyroidism, and 62% adrenal insufficiency.
- Post-surgery, 17 patients showed improved pituitary function, while 8 had persistent hypopituitarism.
- Recovery of thyroid, adrenal, and gonadal function was observed in 57%, 38%, and 32% of affected patients, respectively.
- Normal or mildly elevated preoperative serum PRL and a rise in TSH after TRH predicted recovery.
- Smaller tumors (≤25 mm) were associated with better functional outcomes.
Conclusions:
- Transsphenoidal adenomectomy can lead to significant pituitary function improvement in patients with NFPAs.
- Preoperative assessment of prolactin levels and TSH response to TRH can predict the likelihood of pituitary function recovery.
- Portal circulation compression is a likely mechanism for hypopituitarism in NFPAs.