The Correlation Study Of Hypopituitarism After Pituitary Adenoma Operation

Objective:By observing the clinical characteristics,imaging findings and hormone levels of patients with pituitary adenoma,independent risk factors of hypopituitarism after transsphenoidal pituitary adenoma were screened and a prediction model was established.Methods:A total of 224 patients with pituitary adenoma confirmed by the Department of Pathology of our hospital who were treated in the Department of Neurosurgery of the First Affiliated Hospital of South China University from January 2016 to December 2019 were enrolled.The patients’basic clinical data,tumor pathological types,preoperative and postoperative imaging findings,basic diseases and other data were collected.Follow-up patients were collected by the outpatient case system of our hospital.To compare the law of hypopituitarism after transsphenoidal pituitary adenoma and analyze the influencing factors.SPSS 21.0 and R 3.60 software were used for statistical processing of data.Chi-square test was used for the analysis of counting data and t test was used for the analysis of measurement data.Logistic regression,ROC curve,validation prediction model effectiveness and decision curve were used to analyze the relationship between various influencing factors and postoperative hypopituitarism,and to evaluate the clinical predictive value of postoperative hypopituitarism development of transsphenoidal pituitary adenoma.P<0.05 indicated statistical significance.Result:1、Among the 224 patients in this study,hypopituitarism occurred in 70 cases after pituitary adenoma surgery,with an incidence of31.25%.2、The related factors that may affect postoperative hypopituitarism in patients with pituitary adenoma were divided into groups according to whether there was postoperatively hypopituitarism,and statistically significant differences were found between the two groups in tumor diameter,tumor diameter>30mm,preoperative hypopituitarism,and invasion(P<0.05).3、Univariate regression analysis showed that tumor diameter>30mm,preoperative hypopituitarism and tumor aggressiveness were related to hypopituitarism after pituitary adenoma(P<0.05).4、Multivariate regression analysis of hypopituitarism after pituitary adenoma surgery showed that tumor diameter>30mm(OR=2.25,P<0.05)and preoperative hypopituitarism(OR=2.39,P<0.05)were independent risk factors for hypopituitarism after pituitary adenoma surgery.5、The stepwise regression prediction model showed that logit(P)=-1.5959+0.8180(tumor diameter>30mm)+0.8705(preoperative hypopituitarism),logit(P)=ln(P/1-P).6、The area under the ROC curve to predict the probability of postoperative hypopituitarism was 0.7085,95%CI(0.6392-0.7778),and the AUC under the ROC curve was used to evaluate the diagnostic efficiency.7、After the prediction model was established,the Hosmer-Lemeshow test(x~2=4.0939,df=8,p=0.8486)and the calibration curve were used to detect the goodness of fit of the prediction model,P>0.05 indicates that the difference is not statistically significant,indicating that the prediction model has goodness of efficiency and has certain clinical value.8、Decision curve analysis showed that preoperative hypopituitarism and preoperative tumor diameter>30mm had important clinical value in predicting the development of hypopituitarism after pituitary adenoma surgery,and the net benefit rate was high,suggesting that the application could guide clinical decision making and the benefit degree of patients was high.Conclusions:Based on the analysis of clinical data,this study established independent risk factors,probability prediction model,calibration curve and decision analysis curve for hypopituitarism in patients after pituitary adenoma surgery.By evaluating the clinical significance of the calibration degree and benefit degree of this model,The results showed that preoperative hypopituitarism and tumor diameter>30mm were independent risk factors for hypopituitarism after pituitary adenoma surgery,which could be used for individual risk assessment of patients with pituitarism before transsphenoidectomy,to evaluate high-risk groups with postoperative hypopituitarism,and to guide clinical decision-making.