An analysis of risk factors for preoperative hypofunction of the HPA and HPT axes in patients with pituitary adenoma and their postoperative outcomes

Abstract:

Objective Methods A retrospective analysis was conducted on patients with pituitary adenoma who underwent treatment in the same treatment group at the Department of Neurosurgery，Xinqiao Hospital，Army Medical University，from January 2018 to December 2022. A total of 504 patients were included based on the inclusion and exclusion criteria. The differential clinical factors were compared and analyzed between patients with normal HPA or HPT function（normal function group） and those with hypofunction in at least one of the axes. Multivariate logistic regression was used to analyze the risk factors for preoperative hypopituitarism. The recovery of pituitary function within one year of surgery was followed up in patients who had preoperative hypofunction and underwent surgical treatment.Results The normal function group consisted of 434 patients，while the hypofunction group had 70 patients. The hypofunction group had a higher proportion of elderly patients than the normal function group（P=0.049），with a higher proportion of male patients（P=0.001）. An analysis of complications found that the hypofunction group had a lower proportion of patients with hypertension（P=0.037），but had a higher proportion of patients with hyperlipidemia（P=0.033）. A comparison of tumor characteristics revealed a significant increase in tumor volume in the hypofunction group compared with the normal function group（P<0.001）. Additionally，a smaller proportion of intrasellar tumors developed in the hypofunction group than in the normal function group（P=0.012）. A comparison of endocrine classification showed a significantly higher proportion of nonfunctional adenomas in the hypofunction group than in the normal function group（P<0.001）. There were no significant differences in the remaining clinical variables between the two groups. Multivariate logistic regression analysis revealed that being a male，clinically nonfunctional adenoma，and large tumor volume were independent risk factors for hypofunction of the HPA and HPT axes in patients with pituitary adenoma（P<0.05）. The receiver operating characteristic curve demonstrated that a tumor volume of 6.350 cm³ was an optimal predictor of hypofunction of the HPA and HPT axes（area under the curve［AUC］=0.7）. Sixty-eight patients in the hypofunction group underwent surgical treatment，with 41 cases of hypofunctional HPA axis，53 cases of hypofunctional HPT axis，and 26 cases of hypofunction of both axes. The recovery rates for patients with the hypofunction of the HPA axis，HPT axis，and both axes within one year after surgery were 36.6%，39.6%，and 38.5%，respectively.Conclusion male，large tumor volume，and nonfunctional pituitary adenomas are high risks for HPA and HPT axis hypofunction in patients with pituitary adenoma. Surgery can，to varying degrees，help with the recovery in patients with preoperative hypofunction of the HPA and HPT axes.Being a The hypothalamic-pituitary-adrenal（HPA） and hypothalamic-pituitary-thyroid（HPT） axes are the most vital hormonal axes in the human body. This study aims to investigate the risk factors for the preoperative hypofunction of these axes in patients with pituitary adenoma and the postoperative recovery of corresponding hormonal axes.