The prevalence rate of hypopituitarism in patients with pituitary macroadenomas with various hormonal activities

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Abstract

Rationale: According to the recent epidemiological studies, prevalence of pituitary tumors amounts to 1 per 865 to 2688 adults. The prevalence rates of hypopituitarism in pituitary macroadenomas are highly variable and comprise 37% to 85% among newly diagnosed non-functioning pituitary adenomas (NFPA). There is virtually no data on the prevalence of hypopituitarism in the cohort of newly diagnosed macroadenomas secreting prolactin and somatotropic hormone.

Aim: To assess the prevalence of hypopituitarism in patients with pituitary macroadenomas with various hormonal activities and to identify its potential risk factors.

Materials and methods: We analyzed data from 293 patients with pituitary macroadenomas with various hormonal activities: NFPA (n = 121), prolactinomas (n = 59), and somatotropinomas (n = 113). The patients had been examined before any treatment was commenced.

Results: The prevalence rate of hypopituitarism was 59/121 (39.9%) among the patients with NFPA, 18/59 (27.3%) among those with prolactinomas, and 19/113 (14%) among those with somatotropinomas (р < 0.001). The symptoms of chiasmal compression and chiasmal syndrome were significantly more prevalent in the patients with hypopituitarism, than in those without it in all subgroups. The relative risk of hypopituitarism in the patients with chiasmal compression was 2.10 for NFPA (95% confidence interval (CI) 1.50-2.95, р=0.003), 1.667 for prolactinomas (95% CI 1.292.18, р = 0.005), and 1.45 for somatotropinomas (95% CI 1.56-2.48, р = 0.001). The relative risk of hypopituitarism in the patients with chiasmal syndrome was 1.66 for NFPA (95% CI 1.26-2.18, р=0.009), 2.08 for prolactinomas (95% CI 1.602.69, р = 0.001), and 1.97 for somatotropinomas (95% CI 1.56-2.48, р = 0.005). The NFPA subgroup had the highest rate of hypothyroidism (36/59, 61.0%), whereas the prolactinoma subgroup had the highest rate of secondary hypogonadism (34/59, 57.6%); however, hypogonadism is one of the manifestations of persistent pathological hyperprolactinemia typical for prolactinomas. In the somatotropinoma subgroup, secondary hypothyroidism was found in 11/19 (57.9%) of the patients. Conclusion: Identification of hypopituitarism before any treatment depended on the type of hormonal activity of a pituitary tumor and was most frequent in NFPA. The risk factors for hypopituitarism were chiasmal compression, chiasmal syndrome, vertical diameter of the pituitary tumor, and its volume. Secondary adrenal insufficiency, being the most hazardous component of hypopituitarism, manifested most rarely.

About the authors

Yu. G. Krivosheeva

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: yulya.k.89@inbox.ru
ORCID iD: 0000-0002-2061-5235

Yulia G. Krivosheeva - Research Fellow, Department of Therapeutic Endocrinology.

61/2 Shchepkina ul., Moscow, 129110.

Tel.: +7 (916) 470 60 41.

Russian Federation

I. A. Ilovayskaya

Moscow Regional Research and Clinical Institute (MONIKI)

Email: irena.ilov@yandex.ru
ORCID iD: 0000-0003-3261-7366

Irena A. Ilovayskaya - MD, PhD, Associate Professor, Leading Research Fellow, Department of Therapeutic Endocrinology; Professor, Course of Special Endocrinology, Chair of Endocrinology, Postgraduate Training Faculty.

61/2 Shchepkina ul., Moscow, 129110.

Tel.: +7 (916) 677 26 45.

Russian Federation

References

  1. Molitch ME. Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017;317(5): 516-524. doi: 10.1001/jama.2016.19699.
  2. Chen C, Hu Y, Lyu L, Yin S, Yu Y, Jiang S, Zhou P. Incidence, demographics, and survival of patients with primary pituitary tumors: a SEER database study in 2004-2016. Sci Rep. 2021;11:15155. doi: 10.1038/s41598-021-94658-8.
  3. Ntali G, Wass JA. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary. 2018;21(2):111-118. doi: 10.1007/s11102-018-0869-3.
  4. Белая ЖЕ, Голоунина ОО, Рожинская ЛЯ, Мельниченко ГА, Исаков МА, Луценко АС, Алексеева ТМ, Зенкова ТС, Пржиялковская ЕГ, Панюшкина ГМ, Илюхина ОБ, Иванова ЕИ, Кришталь ЕА, Вачугова АА, Пигарова ЕА, Дзеранова ЛК, Марова ЕИ, Арапова СД, Мамедова ЕО, Гребенникова ТА, Анциферов МБ, Древаль АВ, Дедов ИИ. Эпидемиология, клинические проявления и эффективность различных методов лечения акромегалии по данным единого российского регистра опухолей гипоталамо-гипофизарной системы. Проблемы Эндокринологии. 2020;66(1):93-103. doi: 10.14341/probl10333.
  5. Maione L, Chanson P. National acromegaly registries. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101264. doi: 10.1016/j.beem.2019.02.001.
  6. Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab. 2000;85(5):1789-1793. doi: 10.1210/jcem.85.5.6611.
  7. Mercado M, Melgar V, Salame L, Cuenca D. [Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects]. Endocrinol Diabetes Nutr. 2017;64(7): 384-395. English, Spanish. doi: 10.1016/j.endi-nu.2017.05.009.
  8. Pappachan JM, Raskauskiene D, Raman Kutty V, Clayton RN. Excess mortality associated with hypopituitarism in adults: a meta-analysis of observational studies. J Clin Endocrinol Metab. 2015;100(4):1405-1411. doi: 10.1210/jc.2014-3787.
  9. Margaritopoulos D, Vassiliadi DA, Markou M, Evangelatou E, Tzanela M, Tsagarakis S. Suprasellar extension independently predicts preoperative pituitary hormone deficiencies in patients with nonfunctioning pituitary macroadenomas: a single-center experience. Hormones (Athens). 2020;19(2):245-251. doi: 10.1007/s42000-020-00183-0.
  10. Zhang R, Wang Z, Gao L, Guo X, Feng C, Deng K, Lian W, Yao Y, Feng M, Bao X, Wang R, Xing B. Clinical Characteristics and Postoperative Recovery of Hypopituitarism in Patients with Nonfunctional Pituitary Adenoma. World Neurosurg. 2019;126:e1183-e1189. doi: 10.1016/j.wneu.2019.03.062.
  11. Fleseriu M, Bodach ME, Tumialan LM, Bonert V, Oyesiku NM, Patil CG, Litvack Z, Aghi MK, Zada G. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for Pretreatment Endocrine Evaluation of Patients With Nonfunctioning Pituitary Adenomas. Neurosurgery. 2016;79(4):E527-E529. doi: 10.1227/NEU.0000000000001387.
  12. Araujo-Castro M, Pascual-Corrales E, Acitores Cancela A, Garda Duque S, Ley Urzaiz L, Rodnguez Berrocal V. Status and clinical and radiological predictive factors of presurgical anterior pituitary function in pituitary adenomas. Study of 232 patients. Endocrine. 2020;70(3):584-592. doi: 10.1007/s12020-020-02455-6.
  13. Yeliosof O, Gangat M. Diagnosis and management of hypopituitarism. Curr Opin Pediatr. 2019;31(4):531-536. doi: 10.1097/MOP.0000000000000779.
  14. Jasim S, Alahdab F, Ahmed AT, Tamhane S, Prokop LJ, Nippoldt TB, Hassan Murad M. Mortality in adults with hypopituitarism: a systematic review and meta-analysis. Affiliations Expand Endocrine. 2017;56(1):33-42. doi: 10.1007/s12020-016-1159-3.
  15. Lee IH, Miller NR, Zan E, Tavares F, Blitz AM, Sung H, Yousem DM, Boland MV. Visual Defects in Patients With Pituitary Adenomas: The Myth of Bitemporal Hemianopsia. Am J Roentgenol. 2015;205(5):W512-W518. doi: 10.2214/AJR.15.14527.

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Copyright (c) 2021 Krivosheeva Y.G., Ilovayskaya I.A.

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