Hypogonadotropic hypogonadism in patients with non-functioning pituitary adenomas before and after transsphenoidal surgery - A prospective study

Victor Hantelius; Gudmundur Johannsson; Tobias Hallen; Thomas Skoglund; Oskar Ragnarsson

doi:10.1530/endoabs.99.RC5.3

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Endocrine Abstracts (2024) 99 RC5.3 | DOI: 10.1530/endoabs.99.RC5.3

ECE2024 Rapid Communications Rapid Communications 5: Pituitary and Neuroendocrinology | Part I (8 abstracts)

Hypogonadotropic hypogonadism in patients with non-functioning pituitary adenomas before and after transsphenoidal surgery – A prospective study

Victor Hantelius ^1,2 , Gudmundur Johannsson ^1,2 , Tobias Hallen ^3,4 , Thomas Skoglund ^3,4 & Oskar Ragnarsson ^1,2

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¹Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden; ²Sahlgrenska University Hospital, Department of Medicine, Gothenburg, Sweden; ³Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Department of Clinical Neuroscience, Gothenburg, Sweden; ⁴Sahlgrenska University Hospital, Department of Neurosurgery, Gothenburg, Sweden

Background: Hypopituitarism is common in patients with pituitary tumors. Still, the influence of pituitary tumor surgery on gonadal function and reproductive health remains underexplored.

Objective: a) To assess gonadal function and its impact on quality of life (QoL) in patients with non-functioning pituitary adenomas (NFPA) before and after transsphenoidal surgery (TSS), b) to identify factors that predict recovery of gonadal function following TSS, and c) to investigate sex-specific disparities related to hypogonadotropic hypogonadism (HH).

Methods: From September 2015 to December 2021, 122 patients with NFPA planned for TSS were evaluated. Health related QoL was assessed with two questionnaires, EQ-5D and The Psychological General Well-Being (PGWB) Index.

Results: Before surgery, 74 (61%) of 122 patients had HH. Of 49 women, 24 (49%) had preoperative HH, of whom 9 (38%) had recovered 12 months after TSS. Similarly, 50 (68%) of 73 men had preoperative HH of whom four (8%) recovered. Of 48 patients without preoperative HH, 16 (33%) developed it postoperatively. Of 49 women, 13 (27%) were of reproductive age (<50 years). Eight of these 13 (62%) had preoperative HH, of whom 5 (63%) recovered postoperatively and regained regular menstrual cycles. In contrast, 10 out of 13 (77%) men <50 years of age had preoperative HH, of whom only one (8%) recovered. After 12 months following TSS, the mean EQ-5D-index for the whole cohort (n=122) increased from 0.86 (interquartile range (IQR): 0.77–0.96) to 0.90 (IQR: 0.85–0.98) (P<0.001) and their PGWB-index from 94 (IQR: 80–112) to 104 (IQR: 93–119) (P<0.001). There was no difference in QoL between patients with and without HH, neither before nor after surgery. In the group of 76 with postoperative HH the mean EQ-5D-index increased from 0.86 (IQR: 0.76–0.96) to 0.89 (IQR: 0.82–0.96) (P=0.011) and the PGWB-index increased from 96 (IQR: 84–113) to 103 (IQR: 90–119) (P=0.003). In a multivariable logistic regression analysis, male sex (P=0.022) and high BMI (P=0.036) were associated with postoperative HH, but central hypothyroidism, adrenal insufficiency and growth hormone deficiencies were not.

Conclusions: HH is common in both men and women with NFPA requiring surgical intervention. The recovery rate following TSS is higher in women than in men. The QoL improves for the whole group after surgery. Male sex and high BMI are predictors for persistent postoperative HH.