Endocrine Abstracts

JOINT1273

Introduction: Transsphenoidal surgery (TSS) is the first-line treatment for most patients with pituitary tumors. The tumor, its treatment and comorbidities may significantly affect psychological well-being (PGWB) and self-perceived health. The aim of this study was to identify vulnerable subgroups among patients with pituitary tumors after TSS.

Methods: This prospective study included consecutive patients before TSS (baseline) and 12 months after surgery using the PGWB index and EuroQol Visual Analogue Scale (EQ-VAS) as described in the study protocol¹. We investigated care type (personalized vs standard), clinical characteristics and adrenal insufficiency (AI) at 12-month as determinants of PGWB and EQ-VAS changes post-TSS.

Results: Totally, 148 patients (63 females, 43%), with a median age of 62 years (Q1-Q3 48. 3-69. 8) were included, of whom 118 (80%) had a non-functioning pituitary adenoma (NFPA). Before TSS, young age, female sex, living alone and having a secreting pituitary adenoma were associated with lower baseline PGWB. A subgroup analysis confirmed these findings in patients with NFPA, likewise all variables except sex remained significant in patients with functioning tumors. Similar patterns were seen for self-reported overall health, where young age, female sex and having a secreting tumor were related with lower baseline scores. However, in patients with NFPA, only age remained significant, and no variable correlated with baseline EQ-VAS in the functioning group. In the multivariate regression analysis on the full cohort, a functioning pituitary adenoma was associated with lower improvement in PGWB scores (β -0. 159, P = 0. 036). Similarly, being born outside of Sweden was a negative determinant of EQ-VAS score improvement (β -0. 173, P = 0. 017). Multivariate regression analysis on patients with NFPA showed that male sex and AI at 12-months contributed to less improvements in PGWB score (male sex β -0. 212, P = 0. 025, AI β -0. 225, P = 0. 015). In patients with functioning adenomas also including remission status at 12 months, only being born outside of Sweden (β -0, 331 P = 0. 045) was correlated with less improvement EQ-VAS.

Conclusion: This study suggests that having a functioning pituitary adenoma and being foreign-born are vulnerable subgroups of pituitary tumor patients. The presence of AI among NFPA is also a negative predictor of outcome. These patients may need additional support during the post-operatory period to improve their psychological and overall health.

Reference: 1. Extended Support Within a Person-Centered Practice After Surgery for Patients With Pituitary Tumors: Protocol for a Quasiexperimental Study. JMIR Res Protoc. 2020 Jul 21;9(7):e17697. doi: 10. 2196/17697.