A retrospective analysis of 338 surgically treated pituitary adenomas

To summarize the clinical characteristics, pituitary function assessment, postoperative pathological features, and postoperative recurrence of surgically treated pituitary adenomas (PAs).

We retrospectively reviewed the data of 338 patients (169 women; average age: 50.01 ± 12.47 years) who underwent surgical PA resection at our hospital during 2016-2020. Pathological PA classification was based on postoperative immunohistochemical staining for pituitary hormones. The clinical, imaging, laboratory, and follow-up data of the patients were statistically analyzed using SPSS v25.0.

The main complaints of PA patients were compressive symptoms, followed by endocrine symptoms; 23 tumors were incidentalomas. Compared with the 93 patients with functioning PAs, the 245 patients with non-functioning PAs were older, and had greater tumor diameters and rates of cavernous sinus invasion and pituitary apoplexy (P < 0.05). Postoperative hormonal staining most commonly revealed ACTH (27.4%) and FSH/LH positivity (20.6%); 23.1% of non-functioning tumors stained negative for pituitary hormones. Preoperative anterior hypopituitarism commonly involved the gonadal and thyroid axes, and was correlated with male sex and tumor diameter (P < 0.05). The optimal cut-off for tumor diameter was 1.95 cm for predicting preoperative hypopituitarism in patients with non-functioning PAs. The number of operations and preoperative hypopituitarism were correlated with postoperative pituitary dysfunction (P < 0.05). In the non-functioning PA group, tumor diameter was a risk factor for postoperative recurrence (optimal cutoff: 2.75 cm).

The management of patients with surgically treated PAs is limited by deficiencies in pathological classification, assessment of hypopituitarism, and detection of recurrence.