Socioeconomic Factors and Postoperative Endocrine Outcomes in Pituitary Adenoma Patients

Introduction: Pituitary adenomas, though largely benign, can present with symptoms of mass effect and excess endocrine function. Postoperative endocrine dysfunction is a known complication following endoscopic endonasal pituitary adenoma removal; this includes hyponatremia, diabetes insipidus, adrenal insufficiency, and other pituitary endocrinopathies. Though some research has been conducted into the possible impact of socioeconomic factors on pituitary adenoma surgical outcomes, there has not been a targeted focus on how these factors relate specifically to endocrine complications. In this study, we assess socioeconomic factors and determine their association with postoperative endocrine outcomes in pituitary adenoma patients.

Methods: Following IRB approval, a retrospective chart review was conducted on pituitary adenoma patients (n = 216). Age, gender, race, and insurance status were catalogued. Postoperative endocrine function was noted, and was assessed on the basis of hormonal replacement therapy and/or levels of excess hormone. Postoperative diabetes insipidus and hyponatremia were also noted. Chi-square tests were used to determine significant associations, and were pursued with Bonferroni correction to determine exact correlations.

Results: Gender and insurance status yielded no significant correlations with any endocrine complications. Hispanic populations were significantly more likely to have diabetes insipidus postoperatively than expected (p < 0.0001). African Americans were significantly more likely to have worse endocrine function postoperatively than other racial groups (p < 0.000000001). Younger individuals were more likely to have postoperative diabetes insipidus (p < 0.001).

Conclusion: While age has already been established as a significant factor for postoperative diabetes insipidus, race appears to show significant association with adverse endocrine outcomes following pituitary adenoma removal. This result suggests the presence of racial inequalities within the neuroendocrine field, among both Hispanic and African American populations, that reflects a broader pattern within the United States healthcare system. We hypothesize that this disparity relates to access to care and potentially the chronicity of the adenoma preoperatively. More work is needed, however, to understand the relationship of socioeconomic predictors of health in this patient population.

Publication History

Article published online:
12 February 2021