31 Once panhypopituitarism, always panhypopituitarism?
Altena, M.R., Geelhoed, P.H.L.M.
Locatie(s): Auditorium 2
Categorie(ën): Parallelsessie
Background: Patients with a pituitary tumor and compression of the optic chiasm are treated with transsphenoidal surgery. Recovery of preoperatively pituitary dysfunction after resection is sometimes seen, but rare in panhypopituitarism. Based on one of our patients diagnosed with panhypopituitarism due to a pituitary macroadenoma with full recovery after resection, we performed a literature search to find indicators of postoperative recovery after pituitary surgery.
Methods: First we describe the case of unexpected full recovery. Secondly we searched PubMed using a systematic approach.
Results: Panhypopituitarism in our patient was substituted with hydrocortisone, levothyroxine and testosterone. Immunohistochemical staining of the tumor proved positive for FSH and LH. Postoperative testing for recovery of pituitary function was not performed. One year after resection fasting cortisol level was above 200 nmol/l. Consequently the substitution of the hydrocortisone, thyroxine and testosterone was gradually diminished and pituitary function proved to be fully recovered.
Literature: In a systematic search (PubMed) we found 4 articles with recovery of 1 or more pituitary axis after surgery. We describe the 2 larger studies and predictors of recovery of function. Fatemi et al. analyzed 444 patient treated with transsphenoidal surgery. 49% of patients had any recovery of function but only one patient had recovery of 4 axes. Predictors of recovery were: young age, absence of hypertension and absence of CSF leak. Webb et al. studied 93 patients with preoperative pituitary hypofunction. There was recovery of 2 axes in 7 and of 3 axes in 1 patient. Recovery was less common with nonfunctioning adenomas. Invasive tumor growth was associated with a lower probability of pituitary function recovery after surgery.
There are no guidelines for testing recovery of function after transsphenoidal surgery. However in clinical practice, most patients are tested in the first six months after surgery.
Conclusion: Although rare, pituitary function can return to normal after transsphenoidal resection of a macroadenoma with pituitary hypofunction. Young age, absence of hypertension, absence of CSF leak and non-invasive growth are associated with recovery of function.