Endocrine Abstracts (2008) 15 P259

Pituitary function and vision following surgical intervention for suprasellar meningiomas

Sibylle Kohler, Nicole Stoesser, Niki Karavitakis, Simon Cudlip & John Wass

Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK.

Objective: There is little data on suprasellar meningiomas regarding their effect on pituitary hormones and outcome following surgical intervention.

Methods: In a database of patients undergoing surgical treatment for a pituitary mass set up in 1997, all cases of histologically proven meningioma were identified. Medical records were reviewed in order to determine menigioma site, size, pre- and postoperative vision as well as pre- and postoperative pituitary function.

Results: Out of 551 patients with a pituitary mass, 17 patients were found to have a suprasellar meningioma (3.1%). Complete medical records were available for 12 patients (mean age±S.D., 47.5±9.8, 10 females). 11 patients (91.7%) were symptomatic; 8 patients had visual impairment, 4 patients had low libido or oligomenorrhea and 2 patients suffered from headaches. 11 menigiomas were situated in the suprasellar region and 1 in the sella. The maximum size was 3 cm, all meningiomas were WHO Grade I. 11 patients underwent craniotomy, 1 patient was operated via transphenoidal approach. Preoperative hormone assessment revealed 4 patients with hormone deficiencies (33.3%), all were hypogonadal, 3 were hypothyroid, 2 were growth hormone deficient and 1 was additionally hypoadrenal. Postoperatively, 1 of these patients could discontinue hormone replacement, 1 patient continued on the same treatment but 2 patients needed additional hormone replacement. 3 patients with normal preoperative pituitary function went on to require hormone replacement postoperatively. Of the 8 patients who presented with visual impairment, 6 showed postoperative improvement and 2 patients noted stable vision postoperatively. However, 2 patients with no initial visual impairment were found to have postoperative visual field defects.

Conclusion: Suprasellar meningiomas are a rare entity and can be associated with preoperative hormone deficiencies in a significant minority. Surgical intervention seems to restore pituitary function infrequently. However, surgical intervention can improve and preserve vision in patients with suprasellar meningioma.

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