Pituitary adenoma consistency affects postoperative hormone function: a retrospective study

D. De Alcubierre*^a (Dr), G. Puliani^b (Dr), A. Cozzolino^a (Dr), V. Hasenmajer^a (Dr), M. Minnetti^a (Dr), V. Sada^a (Dr), A. Zaccagnino^c (Dr), C. Pozza^d (Dr), AG. Ruggeri^c (Dr), R. Pofi^a (Dr), E. Sbardella^a (Dr)

^a Department of Experimental Medicine, Sapienza University of Rome, Rome, ITALY ; ^b Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, ITALY ; ^c Department of Neurology and Psychiatry–Neurosurgery Unit, Sapienza University of Rome, Rome, ITALY ; ^d Department of Experimental Medicine, Sapienza University of Rome, Roma, ITALY

* dario.dealcubierre@uniroma1.it

Introduction: Little is known about possible predictors of hormone function following pituitary surgery. Tumor consistency recently emerged as a key factor in surgical planning for pituitary adenomas, but its impact on postoperative endocrine function has yet to be explored. The primary aim of our study was to evaluate the impact of tumor consistency on endocrine and surgical outcomes following transsphenoidal adenomectomy (TSA).

Methods: Our study was a single-center, retrospective analysis of consecutive pituitary adenomectomies performed at Policlinico Umberto I in Rome. All patients underwent radiological and biochemical evaluations at baseline, and hormone assessments 3 and 6 months after pituitary surgery. Postoperative MRI studies were used to determine the resection rates following TSA. A single surgeon performed all surgical procedures and provided data on tumor consistency, macroscopic appearance, neurosurgical approach and intraoperative complications.

Results: 50 patients [24 women, mean age 57±13 years, median tumor volume 4800 mm³ [95% CI; 620-8828], were included. Greater tumor volume (χ²=14.621, p=0.006) and male sex (χ²= 12.178, p <0.001) were associated with worse preoperative endocrine function. All patients underwent TSA without intraoperative complications. Fibrous adenoma consistency was observed in 10% of patients and was associated with a Ki-67 greater than 3% (χ ²=8.154, p=0.04) and with a greater risk of developing postoperative hormone deficiencies (χ ²=4.485, p=0.05, OR=8.571; 95% CI; 0.876-83.908) along with a lower resection rate (χ²=8.148, p=0.004; OR 1.385, 95% CI; 1.040-1.844). Similarly, worse resection rates were observed in tumors with suprasellar extension (χ²=5.048, p=0.02) and CSI (χ²=4.000, p=0.04), resulting in a 6-fold (OR=6.000, 95% CI; 1.129-31.880) and 3-fold (OR=3.857, 95% CI; 0.997-14.916) increase in the risk of lower surgical radicality, respectively.

Conclusions: Predictors of endocrine outcomes following pituitary surgery are still lacking. We demonstrated that tumor consistency might provide useful information about postoperative pituitary function, likely due to its impact on surgical procedures. Further prospective studies with larger cohorts are needed to confirm our preliminary findings.

The author has declared no conflict of interest.