Endocrine Outcomes after Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas

Purpose: Endoscopic transsphenoidal surgery (ETSS) is a well-established method to treat patients with nonfunctioning pituitary adenomas (NFPAs). However, data on the predictors of ETSS on alterations in endocrinologic profiles are scarce for NFPAs in large cohorts. This study aims to assess the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA.

Methods: A retrospective review of consecutive patients who underwent ETSS between 2010 and 2018 at one institution was performed. Recovery or de novo development of hypopituitarism in 209 patients with NFPA who underwent ETSS was analyzed.

Results: Patients with preoperative endocrine deficits (59.8%) in one or more pituitary axes exhibited significantly larger tumor volumes (p = 0.001) compared with those without preoperative endocrine deficits (40.2%). Recovery of preoperative pituitary deficit occurred in all four axes, with the cortisol axis showing the most robust recovery, whereas the thyroid axis was lowest, with 1-year cumulative recovery rates of 44.3% and 6.1%, respectively. New-onset hypopituitarism (17.2%) also occurred in all four axes, most frequently in the thyroid axis (24.3%). Using multivariate analyses, older age was the strongest negative predictor for recovery of both male hypogonadism (p = 0.04) and adrenal insufficiency (p = 0.046).

Conclusion: Dynamic alterations in pituitary hormones levels were noted in a significant proportion of patients following ETSS in NFPA patients. Postoperative endocrine vulnerability, recovery, and factors that predicted recovery or loss of endocrine function varied according to the hormonal system.

Publication History

Article published online:
12 February 2021