Predictors of testosterone recovery in male patients with nonfunctioning pituitary adenoma treated with transnasal transsphenoidal extrapseudocapsular microsurgery

Abstract

Aim: To investigate the predictor of hypothalamic-pituitary-gonadal (HPG) axis recovery in male pituitary adenoma patients with trans-sphenoid extrapseudocapsular microsurgery.

Methods: From June 2019 to December 2021, we retrospectively analyzed the clinical data of gonadal hormone changes and resection degree before and after surgery in male patients with nonfunctioning pituitary adenoma (NFPA) who underwent microsurgical resection by pseudocapsule technique in the same treatment group at the Department of Neurosurgery, Tongji Hospital. We explored the predictors affecting postoperative testosterone recovery using logistics regression analysis.

Results: Among 291 male patients with pituitary adenomas, the mean age was 50 years. Preoperative testosterone was lower than normal in 127 patients (43.6%); total resection and subtotal were performed in 279 patients (95.9%) and 12 patients (4.1%), respectively. Postoperative follicle-stimulating hormone (FSH) was elevated in 224 (77.0%) patients, luteinizing hormone (LH) was elevated in 230 (79.0%) patients, and prolactin was significantly decreased in 259 (89.0%) patients. Seventy-one of 127 patients with low preoperative testosterone levels recovered to normal levels. Univariate and multivariate analysis suggested that tumor size, coagulative necrotic pituitary apoplexy (CNPA), and invasiveness were predictors of testosterone recovery in patients (P < 0.05).

Conclusion: For male NFPA, transsphenoidal extra-pseudocapsule microsurgery can effectively restore the function of the anterior pituitary gland and promote the recovery of testosterone. Tumor size, CNPA and invasiveness were predictors of testosterone recovery in postoperative patients.

Keywords

Coagulative necrotic pituitary apoplexy / extrapseudocapsular transnasal transsphenoidal surgery / male / pituitary adenoma / testosterone

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