Introduction: Hypopituitarism is a common presentation of pituitary lesions. Correction rates for specific deficits postoperatively have not been described in a large enough cohort. We calculated the frequency of the 3 commonest preoperative endocrine deficits (thyroid, testosterone, and cortisol) before 1152-consecutive operations, and determined the correction frequency postoperatively, and preoperative-factors associated with endocrine recovery.
Methods: Restrospective review of perioperative hormones for 1045 consecutive surgeries in the first 946-patients since establishing our dedicated pituitary center five years ago. Hormonal axes were tested preoperatively, and six weeks following surgery.
Results: Pathologies included 340 endocrine-active and 381 endocrine-inactive adenomas, 124 Rathke’s cleft cysts, 50 craniopharyngiomas, and 150 miscellaneous pathologies. 28% of patients presented with hypopituitarism. Rates of preoperative deficits were 13% TSH, 47% testosterone, and 28% for cortisol(P<0.001). Postoperative evaluation was at six weeks, with deficits corrected medically. Correction rates 6-weeks after surgery without hormone replacement were 53% testosterone, 32% thyroid, and 18% cortisol(P<0.001), Higher average preoperative labs were found in patients with postoperative normalization without medical intervention compared to those who did not normalize for TSH(0.2vs0.06), testosterone(81vs64), and cortisol(5.4vs3.0), however this was not statistically significant. None of the patients with preoperative TSH below 0.03µIU/mL, testosterone below 2.0ng/dL, or cortisol below 1µg/dL were corrected with surgery to avoid hormone replacement. Size of lesions in patients with low versus normal TSH or cortisol did not differ(2.4 vs 2.3cm for TSH, 2.5cm each for cortisol, P=0.5), while low testosterone occurred in larger tumors than patients with normal testosterone(2.5 vs. 1.6cm, P<0.05).
Conclusions: After evaluating 1152 pituitary operations and the impact of surgical correction of hormonal deficits, we found testosterone deficiency, the most frequent hormone deficiency associated with pituitary lesions and the only one associated with lesion size, has the highest response to surgical resection, followed by thyroid hormone, while cortisol was least responsive. Preoperative levels below the thresholds specified never corrected with surgery. This information from a large cohort with pathologies representative of those seen in a tertiary care pituitary practice can be used to counsel patients regarding their chances of postoperative endocrine improvement.
Patient Care: By providing rates of surgical correction in addition to hormonal replacement, surgeons can better foresee the benefits of patients who present with specific hormonal deficits and improve decision making
Learning Objectives: Determine the impact of surgery on hormonal correction for patient presenting with hormonal deficits in regards to thyroid, testosterone, and cortisol.