Variable types of pituitary hyposecretion in patients after hypothalamic-pituitary region neurosurgery
DOI:
https://doi.org/10.12923/Keywords:
neurosurgery, hypothalamic- pituitary region, hypopituitarismAbstract
Hypothalamic-pituitary region neurosurgery may result in hormonal changes, including impairment of anterior pituitary hormone secretion and a failure of posterior pituitary to secrete ADH. To minimize postoperative morbidity, a detailed endocrine evaluation followed by adequate management are required in all patients who underwent pituitary surgery. The aim of the study was to determine the forms and frequency of pituitary hypofunction in our patients undergoing neurosurgical treatment. 68 patients (32M and 36F) aged 19-76 were observed in the Department of Endocrinology in 2005–2010. The group covered by the research included 23 subjects (16 F and 7 M) operated on for somatotropinoma, 5 F for Cushing disease, 12 (3F, 9M) for craniopharyngioma, 23 (9F;14M) for non-functioning pituitary adenomas, 2 (1F,1M) for prolactinoma, 2 (1F,1M) for germinoma, 1F for tumor of the sellar region in the course of multiple myeloma. A retrospective review of medical records was conducted. To evaluate the function of the hypophyseal-adrenal cortical axis, ACTH serum concentration, as well as circadian rhythm of cortisol secretion and cortisol daily excretion, were analyzed. The functional states of hypophyseal-thyroid and hypophyseal-gonadal axes were assessed by measuring serum levels of TSH, fT4, fT3 and LH, FSH, testosterone/estradiol, respectively. In addition, serum concentrations of PRL, growth hormone and IGF-1 were studied. Postoperative pituitary hypofunction did not occur in 12 (8F; 4M) ( 17.6%) patients. Other patients showed disturbances in at least one hormonal axis. In 18 (14F;4M) patients only secondary adrenal insufficiency was observed, in 11 – disturbances in two axes and in 12 pts in all three axes were noted, while in 11 pts abnormalities in 3 axes and diabetes insipidus were diagnosed. The most frequently observed pituitary disturbance was hypophyseal-adrenal cortical axis hypofunction (70.6%). Hypophyseal-thyroid axis disturbances developed less frequently (51.5%), whereas hypophyseal-gonadal axes were the least frequent clinical findings (38.2%). Diabetes insipidus was diagnosed in 19 patients. Hypothalamic-pituitary region neurosurgery is associated with a high frequency of variable types of postoperative pituitary hypofunction; therefore, a detailed multihormonal evaluation of the hypophyseal functional status is required in all patients undergoing such neurosurgical treatment.
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