EP1187 - ECE_2820 - PitNETs: clinical characteristics and outcomes following surgical resection from single-center perspective
TL;DR
Surgical resection significantly reduced tumor volume and relieved mass-effect symptoms, despite continued axis dysfunction, and postoperative metabolic changes included a significant increase in body mass index and lower LH levels were associated with a higher likelihood of hypopituitarism.
Abstract
Pituitary tumors (PitNETs) are a heterogeneous group of central nervous system lesions, which account for 13.5%-20% of all primary brain tumors. The aim of the study was to analyze clinical characteristics and postoperative outcomes of patients undergoing PitNET resection. This was longitudinal observational study. Medical records of patients diagnosed with PitNET who were hospitalized pre- and postoperatively at the Department of Endocrinology, Poznan, Poland, between January 2018 and December 2023 were reviewed. All patients underwent surgical resection of a pituitary tumor. Routine postoperative follow-up was scheduled 3-6 months after surgery. The statistical analysis was performed with MedCalc Software Ltd, with significance level set as P < .05. The study included 94 patients, 51 women (54%) and 43 men (46%), with a mean age of 53.7 ± 14.7 years. Non-functioning pituitary adenomas (NFPA) were the most common subtype (63.8%), followed by GH-secreting (18.1%), ACTH-secreting (12.8%), PRL-secreting (4.3%), and TSH-secreting tumors (1.1%). Most tumors were macroadenomas (71%), with microadenomas and giant adenomas comprising 14% and 15%, respectively. Hypopituitarism was observed in 63% of patients, most commonly affecting the gonadotrophic axis (64%), followed by corticotrophic (31%), thyrotrophic (28%), and somatotrophic (4%) axes. Tumor volume after surgery was reduced significantly (P < .0001). Postoperative evaluation demonstrated no radiological evidence of residual tumor in 45% of patients. The prevalence of headaches significantly decreased after surgery (difference −17.1%, 95% CI: −30.5 to −3.6; P = .024), the same as optic chiasm compression (difference −40.9%, 95% CI: −53.0 to −28.9; P < .0001). Lower LH levels were associated with a higher likelihood of hypopituitarism (β = −.128, SE = 0.043, Wald = 8.83, P = .003), corresponding to an odds ratio of 0.88 (95% CI: 0.81-0.96) per unit increase in LH. The number of impaired pituitary axes did not differ significantly before and after surgery (P = .335). Postoperative metabolic changes included a significant increase in body mass index, with a median rise of 0.64 (95% CI: 0.14-1.07; P = .015), as well as a significant increase in body weight, with a median gain of 2.0 kg (95% CI: 0.5-3.5; P = .004). Surgical resection significantly reduced tumor volume and relieved mass-effect symptoms, despite continued axis dysfunction. Lower LH levels pre-surgery might be associated with a higher risk of hypopituitarism. Postoperative weight gain highlights the need for metabolic monitoring.