Postoperative Pituitary Dysfunction And Hormone Replacement Situation In Patients With Pituitary Adenoma

Pituitary adenomas account for around10%to25%of intracranial neoplasms, and they are the third most common intracranial neoplasm in surgery. The goals of surgery is to remove as much tumor as possible, as well as try to protect healthy pituitary tissue. Relief of pressure on the normal pituitary may favor postoperative recovery of hypopituitarism, but pituitary function may also suffer after operation due to pituitary injury. Therefore, pituitary function is needed for postoperative patients, which is usually ignored by patients and surgeons.Symptoms of hypopituitarism are often nonspecific or without any discomfort. Therefore, hypopituitarism is easy to misdiagnosis and will not be given suitable substitution treatment. But the prevalence of complications, such as dyslipidemia and cardiovascular events increase distinctly. Moreover, pituitary crisis usually with coma and shock may occur during periods of acute illness or physical stress, which is life-threatening. Patients of central diabetes insipidus are usually present with significant polyuria and polydipsia, and longtime diuresis could cause kidney damage.Part ⅠThe Situation of Pituitary Function in215Postoperative Patients with Pituitary Adenoma and Analysis of Related FactorsObjective:To investigate the frequency of hypopituitarism and central diabetes insipidus in postoperative patients with pituitary adenoma, and try to find out the potential factors related to postoperative hypopituitarism and diabetes insipidus.Methods:Patients with pituitary adenoma who visited the Department of Endocrinology of Huashan Hospital from January2008to January2011were analyzed. Pituitary function (including gonadal, thyroid axes, adrenal axes and posterior pituitary function) were assessed by strict criteria. Data of surgery history, previous diagnosis and treatment situation and symptoms was collected. SPSS13.0was used for statistical analysis.Results:A total of215postoperative patients were included, of96males and119females. The mean age for all patients was48.47±14.28years. The proportion of hypopituitarism was54.0%(116), and ratio of hypogonadism, hypothyroidism and hypoadrenalism was respectively36.7%、32.6%、28.4%.14patients were diagnosed central diabetes insipidus, and account for6.5%. And the total number of pituitary dysfunction is117(54.4%).Univariate analysis showed that male and larger tumor were related to hypopituitarism, whereas age and pathologic type not. However, Logistic regression analysis showed tumor size was not significantly associated with hypopituitarism after adjustment for sex and age, while male may be an independent risk factor with odds ratio2.43. The prevalence of central diabetes insipidus have no significant relationship with age, sex, MRI tumor size and pathologic type. But pituitary apoplexy and secondary surgery were related to diabetes insipidus, and relative risk is7.1,6.3respectively.Conclusion:After pituitary adenomectomy, approximately half patients present anterior or posterior pituitary dysfunction. Male may be an independent risk factor of hypopituitarism, while pituitary apoplexy and secondary surgery were related to diabetes insipidus.Part ⅡThe Substitution Treatment Status in Postoperative Patients with Pituitary Adenoma Who Suffered From Pituitary DysfunctionObjective:To investigate the situation of hormone replacement in patient with pituitary adenoma who suffered from hypopituitarism or central diabetes insipidus.Methods:Pituitary function of patients with pituitary adenoma who visited the Department of Endocrinology of Huashan Hospital from January2008to January2011were evaluated, and those diagnosed hypopituitarism or central diabetes insipidus were included in the study. Data of substitution treatment status was collected by questionnaire.Results:A total of117patients with pituitary dysfunction were included, of66males and51females. The mean age was50.14±13.83years. The substitution proportion of GnH deficiency was35.9%(14/39) in males younger than60years, and13.3%(2/15) in females younger than50years.84.3%(59/70) of ACTH deficiency was underwent glucorticoid treatment, with86.4%(51/59) taking cortisone acetate and the rest taking pridisone.80.3%(49/61) of patients with TSH deficiency treated with levothyroxine, whereas there were44.9%(22/49) of patients without enough substituted. And78.6%of central diabetes insipidus were underwent hormone substitution.Conclusion:Quite a part of patients with pituitary dysfunction had not appropriate hormone substitution, and substitution of GnH deficiency was least.