Factors Asssociated with Hypopituitarism Reversibility After Neurosurgical Treatment of Pituitary Adenomas in Indonesia

Abstract

Background: Surgery is the treatment of choice for many pituitary tumors. Pituitary function may decline after operation, but relief of the pressure on the normal pituitary may also favor postoperative recovery of hypopituitarism. There is no clear predictor to assess the reversibility of hypopituitarism after neurosurgical treatment of pituitary adenomas. The aim of this study is to identify the factors associated with hypopituitarism reversibility after neurosurgical treatment of pituitary adenomas. Methods: Pre-and postoperative anterior pituitary functions were investigated in 107 patients with pituitary adenomas in our teaching hospital, Siloam Hospital Lippo Village between year 2013 and 2015. Bivariate analysis was done using Chi-Square or Fisher Exact Test. Results: The mean age of the patients was 42.9 (615.9) years. Preoperatively, 43 patients were deficient in at least 1 pituitary hormone after surgery, 21 (49%) recovered between 1 and 3 hormones. The 4 patients with LH/FSH-and TSH-secreting macroadenomas did not recover pituitary function. Factors associated with a higher probability of postoperative pituitary function recovery were no tumor rests on postoperative pituitary imaging (p =0.009), no preoperative hyperprolactinoma (p = 0.021), no pathological evidence of an invasive nature (p = 0.004) and male gender (p =0.044). Diabetes mellitus and tumor size did not have any significant association with the hypopituitarism reversibility. Conclusion: The finding showed that no tumor rests on postoperative pituitary imaging, no pre-operative hyperprolactinemia, no pathological evidence of an invasive nature and male gender are the factors affecting hypopituitarism reversibility after neurosurgical treatment of pituitary adenomas.