Vol 55, No 1 (2021)
Review Article
Published online: 2020-12-09
Submitted: 2020-07-03
Accepted: 2020-09-03
Get Citation

Meta-analysis on the effect of pituitary adenoma resection on pituitary function

Jia-Sheng Ju, Tao Cui, Gui-Wen Chen, Jian-Liang Chen, Hai-Bing Ju
DOI: 10.5603/PJNNS.a2020.0093
·
Pubmed: 33300116
·
Neurol Neurochir Pol 2021;55(1):24-32.

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Vol 55, No 1 (2021)
Review articles
Published online: 2020-12-09
Submitted: 2020-07-03
Accepted: 2020-09-03

Abstract

Objective. A meta-analysis was conducted on the effect of pituitary adenoma resection on pituitary function.

Methods. The Cochrane Library, Ovid, PubMed, the Excerpta Medica Database (EMBASE), and the Chinese Biomedical Literature Databases (CBM) were searched to find trials about the evaluation of pituitary target glands before and after pituitary adenoma resection. The databases were searched from the earliest available trials until the end of September 2019. Based on the inclusion and exclusion criteria, two researchers independently selected literature, extracted data, and evaluated the quality of the studies, and then used Revman 5.2 software to conduct a meta-analysis.

Results. Eleven clinical trials were included, with a total of 3,237 subjects. Meta-analysis showed that the number of patients with hypofunction of the thyroid and gonadal axes substantially decreased after pituitary tumour resection, and that the difference was statistically significant: odds ratio (OR) = 1.72 [95% confidence interval (CI), 1.18–2.52; P = 0.005] and OR = 2.06 (95% CI, 1.42–3.00; P = 0.0002). The number of patients with a poor total suprarenal gland axis after pituitary tumour resection did not change significantly compared to the number found before the operation; the difference was not statistically significant: OR = 1.04 (95% CI, 0.72–1.48; P = 0.85). However, the number of patients who had adrenal axis dysfunction both before and after the operation was significantly reduced, and the difference was statistically significant: OR = 1.46 (95% CI, 1.21–1.78; P = 0.0001).

Conclusion. The function of the thyroid and gonadal axes of pituitary gland tumour patients can be improved, to some extent, after pituitary tumour resection. Patients with pituitary tumours who have hypofunction of the adrenal axis can recover effectively after tumour resection.

Abstract

Objective. A meta-analysis was conducted on the effect of pituitary adenoma resection on pituitary function.

Methods. The Cochrane Library, Ovid, PubMed, the Excerpta Medica Database (EMBASE), and the Chinese Biomedical Literature Databases (CBM) were searched to find trials about the evaluation of pituitary target glands before and after pituitary adenoma resection. The databases were searched from the earliest available trials until the end of September 2019. Based on the inclusion and exclusion criteria, two researchers independently selected literature, extracted data, and evaluated the quality of the studies, and then used Revman 5.2 software to conduct a meta-analysis.

Results. Eleven clinical trials were included, with a total of 3,237 subjects. Meta-analysis showed that the number of patients with hypofunction of the thyroid and gonadal axes substantially decreased after pituitary tumour resection, and that the difference was statistically significant: odds ratio (OR) = 1.72 [95% confidence interval (CI), 1.18–2.52; P = 0.005] and OR = 2.06 (95% CI, 1.42–3.00; P = 0.0002). The number of patients with a poor total suprarenal gland axis after pituitary tumour resection did not change significantly compared to the number found before the operation; the difference was not statistically significant: OR = 1.04 (95% CI, 0.72–1.48; P = 0.85). However, the number of patients who had adrenal axis dysfunction both before and after the operation was significantly reduced, and the difference was statistically significant: OR = 1.46 (95% CI, 1.21–1.78; P = 0.0001).

Conclusion. The function of the thyroid and gonadal axes of pituitary gland tumour patients can be improved, to some extent, after pituitary tumour resection. Patients with pituitary tumours who have hypofunction of the adrenal axis can recover effectively after tumour resection.

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Keywords

pituitary tumour, pituitary function, adrenal glands, thyroid gland, meta-analysis

About this article
Title

Meta-analysis on the effect of pituitary adenoma resection on pituitary function

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 55, No 1 (2021)

Article type

Review Article

Pages

24-32

Published online

2020-12-09

DOI

10.5603/PJNNS.a2020.0093

Pubmed

33300116

Bibliographic record

Neurol Neurochir Pol 2021;55(1):24-32.

Keywords

pituitary tumour
pituitary function
adrenal glands
thyroid gland
meta-analysis

Authors

Jia-Sheng Ju
Tao Cui
Gui-Wen Chen
Jian-Liang Chen
Hai-Bing Ju

References (23)
  1. Little AS, Gardner PA, Fernandez-Miranda JC, et al. TRANSSPHER Study Group. Pituitary gland recovery following fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenoma: results of a prospective multicenter study. J Neurosurg. 2019 [Epub ahead of print]: 1–7.
  2. Bellut D, Hlavica M, Muroi C, et al. Impact of intraoperative MRI-guided transsphenoidal surgery on endocrine function and hormone substitution therapy in patients with pituitary adenoma. Swiss Med Wkly. 2012; 142: w13699.
  3. Barzaghi LR, Losa M, Capitanio JF, et al. Microsurgical therapy of pituitary adenomas. Endocrine. 2018; 59(1): 72–81.
  4. Wani RU, Misgar RA, Bhat MH, et al. Presentation, Morbidity and Treatment Outcome of Acromegaly Patients at a Single Centre. Indian J Endocrinol Metab. 2019; 23(4): 433–437.
  5. Zhang R, Wang Z, Gao Lu, et al. Clinical Characteristics and Postoperative Recovery of Hypopituitarism in Patients with Nonfunctional Pituitary Adenoma. World Neurosurg. 2019; 126: e1183–e1189.
  6. Jahangiri A, Wagner JR, Han SW, et al. Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas: rate, time course, and radiological analysis. J Neurosurg. 2016; 124(3): 589–595.
  7. Garg MK, Tandon N, Gupta N, et al. Target Gland Functional Status in Patients with Non-Cushing's Pituitary Macroadenomas Undergoing Transsphenoidal Microsurgery. : 221–6.
  8. Mason RB, Nieman LK, Doppman JL, et al. Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg. 1997; 87(3): 343–351.
  9. Song C, Zhang NN, Hu Y, et al. Study of pituitary function protection in the surgical treatment of pituitary adenomas. Journal of Clinical Neurosurgery. 2019; 16(2): 115–118.
  10. Kurosaki M, Lüdecke DK, Flitsch J, et al. Surgical treatment of clinically nonsecreting pituitary adenomas in elderly patients. Neurosurgery. 2000; 47(4): 843–8; discussion 848.
  11. He Y, Zhang HQ, Li Y, et al. Pituitary Function in Acute Pituitary Stroke Patients Before and After Transsphenoidal Surgery. Chinese Journal of Microinvasive Neurosurgery. 2015; 10(12): 535–537.
  12. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011; 127(1 Suppl): S1–55.
  13. Kari E, Oyesiku NM, Dadashev V, et al. Comparison of traditional 2-dimensional endoscopic pituitary surgery with new 3-dimensional endoscopic technology: intraoperative and early postoperative factors. Int Forum Allergy Rhinol. 2012; 2(1): 2–8.
  14. Andela CD, Lobatto DJ, Pereira AM, et al. How non-functioning pituitary adenomas can affect health-related quality of life: a conceptual model and literature review. Pituitary. 2018; 21(2): 208–216.
  15. Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2012; 84(8): 843–849.
  16. Greenman Y. Relative sparing of anterior pituitary function in patients with growth hormone-secreting macroadenomas: comparison with nonfunctioning macroadenomas. Journal of Clinical Endocrinology & Metabolism. 1995; 80(5): 1577–1583.
  17. Nemergut EC, Zuo Z, Jane JA, et al. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005; 103(3): 448–454.
  18. Molitch ME. Diagnosis and Treatment of Pituitary Adenomas: A Review. JAMA. 2017; 317(5): 516–524.
  19. Fatemi N, Dusick J, Mattozo C, et al. PITUITARY HORMONAL LOSS AND RECOVERY AFTER TRANSSPHENOIDAL ADENOMA REMOVAL. Neurosurgery. 2008; 63(4): 709–719.
  20. Colao A, Cerbone G, Cappabianca P, et al. Effect of surgery and radiotherapy on visual and endocrine function in nonfunctioning pituitary adenomas. J Endocrinol Invest. 1998; 21(5): 284–290.
  21. Nomikos P, Ladar C, Fahlbusch R, et al. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas -- a study on 721 patients. Acta Neurochir (Wien). 2004; 146(1): 27–35.
  22. Webb SM, Rigla M, Wägner A, et al. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999; 84(10): 3696–3700.
  23. Lamberts SWJ. Hypopituitary control and complications study (HypoCCS): a decade of an outcomes assessment observational study. J Endocrinol Invest. 2008; 31(9 Suppl): 2–5.

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