Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 11:14:1327404.
doi: 10.3389/fendo.2023.1327404. eCollection 2023.

Prognostic indicators in pituitary adenoma surgery: a comprehensive analysis of surgical outcomes and complications

George Riley  1 , Nicolas Scheyer  1 , Marc Klein  1 , Isabelle Merlot  2 , Bruno Guerci  1 , Elodie Jeanbert  3 , Lea Demarquet  1
Affiliations

Prognostic indicators in pituitary adenoma surgery: a comprehensive analysis of surgical outcomes and complications

George Riley et al. Front Endocrinol (Lausanne). .

Abstract

Objective: The primary aim of this study was to identify predictive factors associated with onset of de-novo clinically significant pituitary insufficiencies following endoscopic endonasal surgery (EES) for pituitary adenomas. The secondary objective explored the predictive factors of surgical success.

Methods: A retrospective analysis was conducted on 211 patients who underwent EES. Logistic regression models were employed for the primary and secondary objectives. Patients were stratified into specific groups based on surgical indications and prolactin levels for nuanced analysis.

Results: Significant predictors for de-novo pituitary insufficiencies included male sex (OR 3.3, CI95% 1.3-8.1, p=0.01), immediate postoperative insufficiencies (OR 5.6, CI95% 2.8-11.1, p<0.001), and HYPRONOS criteria (OR 5.7, CI95% 1.6-20.9, p=0.008). For surgical success, preoperative insufficiencies (OR 0.7, CI95% 0.5-0.9, p=0.008), repeat surgeries (OR 0.1, CI95% 0-0.4, p=0.001), and gonadotroph or somatotroph adenomas were significant. Age and adenoma size were not predictive in multivariate analysis. Furthermore, we observed a "dip and recover" effect of prolactin after surgery and lower prolactin levels at follow-up (< 3 ng/ml) are correlated with more anterior pituitary insufficiencies than normoprolactinemic patients (p = 0.004).

Conclusion: This study identifies key predictors for outcomes in pituitary surgery. Our research is the first to employ individualized success criteria for EES, challenging existing perceptions about the role of age and adenoma size. These findings open avenues for nuanced, individualized preoperative risk assessment and postoperative management.

Trial registration: ClinicalTrials.gov NCT06053437.

Keywords: adenoma; endoscopic endonasal surgery (EES); nonfunctioning pituitary adenoma (NFPA); pituitary adenoma (PA); pronostic and predictive factors; surgery complications and outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The left panel presents a forest plot of the univariate regression, illustrating the odds ratios (ORs) for various variables in relation to de novo clinically significant pituitary insufficiencies of the 4-month follow up. The right panel displays variables-retained after stepwise selection in the multivariate regression analysis. Data are represented as ORs with 95% confidence intervals. Rank, not first time surgery; HED, hydroelectrolytic disorders.
Figure 2
Figure 2
The left panel presents a forest plot of the univariate regression, illustrating the odds ratios (ORs) for various variables in relation to EES success. The right panel displays variables retained after stepwise selection in the multivariate regression analysis. Data are represented as ORs with 95% confidence intervals. ORs < 1 indicate negative predictors of surgical success. Rank, not first time surgery; HED, hydroelectrolytic disorders.
See this image and copyright information in PMC

References

    1. Gittleman H, Ostrom QT, Farah PD, Ondracek A, Chen Y, Wolinsky Y, et al. . Descriptive epidemiology of pituitary tumors in the United States, 2004-2009. J Neurosurg (2014) 121:527–35. doi: 10.3171/2014.5.JNS131819 - DOI - PubMed
    1. Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe H-J, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol (2007) 156:203–16. doi: 10.1530/eje.1.02326 - DOI - PubMed
    1. Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, et al. . Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab (2011) 96:894–904. doi: 10.1210/jc.2010-1048 - DOI - PMC - PubMed
    1. Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S, et al. . Management of clinically non-functioning pituitary adenoma. Annales d’Endocrinologie (2015) 76:239–47. doi: 10.1016/j.ando.2015.04.002 - DOI - PubMed
    1. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, et al. . Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol (Oxf) (2006) 65:265–73. doi: 10.1111/j.1365-2265.2006.02562.x - DOI - PubMed

Associated data