World neurosurgery 2017 05 24() pii S1878-8750(17)30439-4
Previous studies have suggested that postoperative hypopituitarism in patients with non-sellar 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 pre-existing hypopituitarism and related risk factors can improve perioperative management for patients with non-sellar intracranial tumors.
Chart data were collected retrospectively from 83 patients with non-sellar 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, cerebrospinal fluid content, and pituitary morphology.
A total of 30 (36.14%) patients 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 non-sellar intracranial tumor include an acute or subacute course (≤ 3 months), intracranial hypertension(intracranial pressure,ICP> 200 mmH2O), 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 non-sellar intracranial tumors (P < 0.05, OR = 3.197). CONCLUSIONS
Prevalence of hypopituitarism is high in patients with non-sellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤ 3 months), intracranial hypertension (ICP > 200 mmH2O), and mass effect (P < 0.05). Mass effect is an independent risk factor for hypopituitarism.