A Higher Tumor Resection Rate Can Increase the Chance of Postoperative Adrenal Insufficiency Recovery in Nonfunctioning Pituitary Adenomas

Objective: Endonasal transsphenoidal surgery (ETS) is an established treatment for patients with nonfunctioning pituitary adenomas (NFPAs). However, few data are available regarding the rates of preoperative hypopituitarism and postoperative recovery in NFPA patients undergoing ETS, as well as factors that predict endocrinological outcomes before and after ETS. This study aimed to identify factors associated with endocrinological outcomes following ETS for patients with NFPA, especially for postoperative recovery.

Methods: This retrospective study included 450 patients with NFPAs who underwent ETS between January 2013 and November 2023. The rates of preoperative hypopituitarism and postoperative recovery were analyzed. Postoperative hypopituitarism recovery was defined as the return to a normal hormone level at least 24 hours following the discontinuation of hormone supplementation, as well as the resolution of the patient’s symptoms.

Results: The baseline patient characteristics are summarized in [Table 1].

The median follow-up period for the entire cohort was 52 months (range: 1–131 months). A total of 246 (55%) patients had one or more pituitary axes dysfunction. Fifty-three (47%) of 114 patients with preoperative adrenal insufficiency (AI) showed postoperative AI recovery. The cumulative AI recovery rates at 1, 3, 6, and 12 months were 12, 19, 32, and 41%, respectively ([Fig. 1]). The patients with smaller tumor sizes of less than 20 mm (log-rank test, p = 0.001; [Fig. 2]) and those with tumor resection rates of more than 85% (log-rank test, p = 0.032; [Fig. 3]) demonstrated better postoperative AI improvement.

Bivariate Cox proportional hazards analysis supported that smaller tumor sizes (continuous, hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.93–0.99; p = 0.043; [Table 2]) and higher tumor resection rates (HR: 1.03, 95% CI: 1.01–1.07; p = 0.001; [Table 2]) were significantly associated with better postoperative AI recovery. Multivariable analysis also revealed that only higher tumor resection rates were significantly associated with better postoperative AI recovery (HR: 1.03, 95% CI: 1.01–1.06; p = 0.019; [Table 2]).

Postoperative hypothyroidism and hypogonadism recovery were not associated with these factors.

Conclusion: Our findings suggest that adequate tumor resection might be essential to achieve successful postoperative AI recovery in NFPAs with preoperative hypopituitarism.

Publication History

Article published online:
07 February 2025