The Study On The Preoperative And Postoperative Changes Of The Pituitary Hormone Levels

objective：To study the characteristic changes of preoperative hormone and thedynamic changes of postoperative hormone levels of patients who were collectedwith pituitary adenomas in our department, and to assess the relevant factors ofhypopituitarism before operation, providing a theoretical basis to predict pituitaryfunction.Method：218cases of pituitary adenoma patients (later histologically verified) whoundergone microscopic endonasal transsphenoidal surgery between January2011and December2013in our department were included in this retrospective analysis.81cases were accepted for this study. There were43males and38females.Classification was accorded to immunohistochemical, there were21null celladenomas,18PRL adenomas,9GH adenomas,9plurihormonal adenomas,2TSHadenomas,4ACTH adenomas and18gonadotropic adenomas. Clinicalendocrinology diagnosis was based on clinical manifestations and endocrine levels,NFPA was47cases (21cases of null cell adenomas,18cases of gonadotropinadenomas,8cases of silent adenomas). Information was documented in the notes onthe medications, tumor size, invasion; pre-and postoperative (1day,7days, and4months after surgery, individually) hormone levels were recorded and compared bySPSS13.0software. Comparisons were performed by the chi-square test, Fisher’sexact test, repeated measures analysis of variance, and logistic regression models.Statistical significance was considered P <0.05.Results：①In order to reflect the overall secretion of pituitary, this is the first studyproposing the concept of “total hormone level”(ie pituitary hormone group).According to the basis of ratio between pre-and postoperative hormonal status ofeach (including PRL, GH, FSH, LH, TSH and ACTH) were calculated, then addedthe ratio together to obtain the “total hormone value”. Total hormone levels have a rise trend in1day,7days and4months after surgery gradually.②In NFPA patients,preoperative and postoperative1day,7days postoperatively, after4months ofhormonal changes were analyzed by repeated measures analysis of variance, reducethe most degree of postoperative pituitary hormone is PRL among the six hormones.The preoperative and postoperative (1day,7days, and4months after surgery) PRLlevels was (23.25±24.42)ng/mL,(7.90±6.82)ng/mL,(8.02±5.76)ng/mL and(9.37±7.23)ng/mL respectively. PRL levels in different period were statisticallysignificant, And after1day and7days, after1day and4months,7days aftersurgery and4months were no significant difference.③Hormones (includingPRL, GH, FSH, LH, TSH and ACTH) were no statistical different between1daypostoperatively and7day postoperatively (P>0.05) in each group.④Of all pituitaryadenomas with preoperative serum PRL levels200ng/mL as a dividing point,patients with Serum PRL>200ng/mL and PRL <200ng/mL of pituitary adenomaswere significantly different in the extent of surgical resection.⑤Logistic regressionanalysis was carried out by the relevant factors of preoperative hypopituitarism in81patients with pituitary adenomas, Age and preoperative tumor volume weresignificant relationship with preoperative hypopituitarism (P <0.05).Conclusion：①T ranssphenoidal resection of pituitary adenomas has an impact onPRL.Postoperative PRL level was significantly lower, however, total hormonetrended to rise in4months after surgery.1day and7days after surgery, thehormone levels are substantially similar.②m ore than200ng/mL of serum PRL levelwas correlated with the extent of resection of pituitary adenomas.③Age andpreoperative tumor volume were independent risk factors of preoperativehypopituitarism (P <0.05).