Analysis of Factors Related to Hypopituitarism in Patients with Nonsellar Intracranial Tumor

• Published in: World neurosurgery Vol. 105; pp. 7 - 13
• Main Authors: Lu, Song-Song, Gu, Jian-Jun, Luo, Xiao-Hong, Zhang, Jian-He, Wang, Shou-Sen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adult; Aged; Brain Neoplasms - surgery; Female; Humans; Hypopituitarism; Hypopituitarism - etiology; Intracranial Hypertension - etiology; Intracranial Pressure - physiology; Male; Mass effect; Middle Aged; Neurosurgery; Neurosurgical Procedures - methods; Nonsellar intracranial tumor; Pituitary function; Pituitary function; MRI; COR; FT4; ACTH; TSH; Nonsellar intracranial tumor; Mass effect; E2; Hypopituitarism; T; CSF; ICP; FSH; LH; Cortisol; Cerebrospinal fluid; Intracranial pressure; Estradiol; Luteinizing hormone; Follicle-stimulating hormone; Testosterone; Thyroid-stimulating hormone; Adrenocorticotropic hormone; Magnetic resonance imaging; Free thyroxine
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2017.03.116

Previous studies have suggested that postoperative hypopituitarism in patients with nonsellar intracranial tumors is caused by traumatic surgery. However, with development of minimally invasive and precise neurosurgical techniques, the degree of injury to brain tissue has been reduced significantly, especially for parenchymal tumors. Therefore, understanding preexisting hypopituitarism and related risk factors can improve perioperative management for patients with nonsellar intracranial tumors. Chart data were collected retrospectively from 83 patients with nonsellar intracranial tumors admitted to our hospital from May 2014 to April 2015. Pituitary function of each subject was determined based on results of preoperative serum pituitary hormone analysis. Univariate and multivariate logistic regression methods were used to analyze relationships between preoperative hypopituitarism and factors including age, sex, history of hypertension and secondary epilepsy, course of disease, tumor mass effect, site of tumor, intracranial pressure (ICP), cerebrospinal fluid content, and pituitary morphology. A total of 30 patients (36.14%) presented with preoperative hypopituitarism in either 1 axis or multiple axes; 23 (27.71%) were affected in 1 axis, and 7 (8.43%) were affected in multiple axes. Univariate analysis showed that risk factors for preoperative hypopituitarism in patients with a nonsellar intracranial tumor include an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H2O), and mass effect (P < 0.05). Multivariate logistic regression analysis showed that mass effect is an independent risk factor for preoperative hypopituitarism in patients with nonsellar intracranial tumors (P < 0.05; odds ratio, 3.197). Prevalence of hypopituitarism is high in patients with nonsellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H2O), and mass effect (P < 0.05). Mass effect is an independent risk factor for hypopituitarism.