Target gland functional status in patients with non-Cushing's pituitary macroadenomas undergoing transsphenoidal microsurgery.

ABSTRACT

OBJECTIVES: Hypopituitarism occurring in patients with pituitary macroadenoma may be reversible after pituitary microsurgery, and surgery itself can lead to hypopituitarism. This study was undertaken to evaluate target gland function prospectively in patients of non-Cushing's pituitary macroadenoma undergoing trans-sphenoidal microsurgery. MATERIAL AND METHODS: A prospective study of fifty patients of non-Cushing's pituitary adenoma was carried out to evaluate target gland (thyroid, adrenal and gonadal) undergoing trans-sphenoidal microsurgery. Thirty-two patients completed postoperative evaluation before radiotherapy. Target gland functions were assessed by measurement of T3, T4, TSH, basal and stimulated cortisol, LH, FSH, testosterone and estradiol. GH and PRL were also measured. Tumor size was assessed on CT/MRI scan. RESULTS: Hypothyroidism, hypoadrenalism and hypogonadism were present in 24%, 54% and 52% of patients. Preoperative hypopituitarism correlated with tumour size. Thyroid, adrenal and gonadal function improved in 87%, 50% and 31%; deteriorated in 4%, 29%, and 37%, respectively after trans-sphenoidal microsurgery. CONCLUSIONS: A subset of patients with non-Cushing's pituitary macroadenoma suffers from hypopituitarism, which reverses after surgery. Failure of recovery correlates with preoperative lower serum prolactin levels.