Skip to main content
Top

25-04-2024 | Hyperprolactinemia | Original Article

Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery

Authors: Kiyohiko Sakata, Aya Hashimoto, Nobuyuki Takeshige, Kimihiko Orito, Ayako Nagayama, Kenji Ashida, Masatoshi Nomura, Motohiro Morioka

Published in: Endocrine

Login to get access

Abstract

Purpose

Non-functioning pituitary adenomas (NFPAs) are often associated with hyperprolactinemia, which is known as the “stalk effect”. However, the relationships between hyperprolactinemia and the radiographic characteristics of the tumor that affects the pituitary stalk have not been well characterized. We aimed to identify the differences in the clinical and radiographic characteristics of patients with NFPA, with and without hyperprolactinemia.

Methods

We enrolled 107 patients with NFPA and allocated them to hyperprolactinemia and non-hyperprolactinemia groups using two different cut-off values: (1) the upper limit of the normal reference range, adjusted for sex and menopausal status, and (2) the upper quartile across the cohort, and compared their clinical and radiographic characteristics. These analyses were conducted to clarify the relationship between the “stalk effect” and the postoperative change in antidiuretic hormone secretion.

Results

The specific radiographic characteristics of the patients included the presence of a cystic or hemorrhagic tumor and the presence of pituitary stalk deviation, which were more frequent in the patients with hyperprolactinemia. Interestingly, the incidence of postoperative transient diabetes insipidus was statistically significantly higher in the hyperprolactinemia group (≥40 ng/mL) and in the group with radiologic evidence of stalk deviation, which were shown to be independent risk factors on multivariate analysis.

Conclusion

The presence of a “stalk effect” was associated with a higher risk of postoperative transient diabetes insipidus, reflecting perioperative pituitary stalk dysfunction following NFPA surgery, especially in patients with serum prolactin concentrations ≥40 ng/mL and radiologic evidence of stalk deviation.
Literature
8.
go back to reference S. Petersenn, M. Fleseriu, F.F. Casanueva, A. Giustina, N. Biermasz, B.M.K. Biller, M. Bronstein, P. Chanson, H. Fukuoka, M. Gadelha, Y. Greenman, M. Gurnell, K.K.Y. Ho, J. Honegger, A.G. Ioachimescu, U.B. Kaiser, N. Karavitaki, L. Katznelson, M. Lodish, D. Maiter, H.J. Marcus, A. McCormack, M. Molitch, C.A. Muir, S. Neggers, A.M. Pereira, R. Pivonello, K. Post, G. Raverot, R. Salvatori, S.L. Samson, I. Shimon, J. Spencer-Segal, G. Vila, J. Wass, S. Melmed, Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat. Rev. Endocrinol. 19, 722–740 (2023). https://doi.org/10.1038/s41574-023-00886-5CrossRefPubMed S. Petersenn, M. Fleseriu, F.F. Casanueva, A. Giustina, N. Biermasz, B.M.K. Biller, M. Bronstein, P. Chanson, H. Fukuoka, M. Gadelha, Y. Greenman, M. Gurnell, K.K.Y. Ho, J. Honegger, A.G. Ioachimescu, U.B. Kaiser, N. Karavitaki, L. Katznelson, M. Lodish, D. Maiter, H.J. Marcus, A. McCormack, M. Molitch, C.A. Muir, S. Neggers, A.M. Pereira, R. Pivonello, K. Post, G. Raverot, R. Salvatori, S.L. Samson, I. Shimon, J. Spencer-Segal, G. Vila, J. Wass, S. Melmed, Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. Nat. Rev. Endocrinol. 19, 722–740 (2023). https://​doi.​org/​10.​1038/​s41574-023-00886-5CrossRefPubMed
9.
go back to reference M. Fleseriu, M.E. Bodach, L.M. Tumialan, V. Bonert, N.M. Oyesiku, C.G. Patil, Z. Litvack, M.K. Aghi, G. Zada, Congress of neurosurgical surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery 79, E527–E529 (2016). https://doi.org/10.1227/NEU.0000000000001387CrossRefPubMed M. Fleseriu, M.E. Bodach, L.M. Tumialan, V. Bonert, N.M. Oyesiku, C.G. Patil, Z. Litvack, M.K. Aghi, G. Zada, Congress of neurosurgical surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery 79, E527–E529 (2016). https://​doi.​org/​10.​1227/​NEU.​0000000000001387​CrossRefPubMed
10.
go back to reference F. Zhang, Y. Huang, C. Ding, G. Huang, S. Wang, The prevalence of hyperprolactinemia in non-functioning pituitary macroadenomas. Int. J. Clin. Exp. Med 8, 18990–18997 (2015)PubMedPubMedCentral F. Zhang, Y. Huang, C. Ding, G. Huang, S. Wang, The prevalence of hyperprolactinemia in non-functioning pituitary macroadenomas. Int. J. Clin. Exp. Med 8, 18990–18997 (2015)PubMedPubMedCentral
24.
go back to reference G. Hildebrandt, H.W. Mueller, H. Stracke, Z.M. Rap, N. Klung, Different types of postoperative diabetes insipidus and the relation to basal and stimulated serum prolactin levels in patients with hypothalamo-hypophyseal tumorous lesions. Acta Neurochir. 104, 110–120 (1990). https://doi.org/10.1007/BF01842828CrossRefPubMed G. Hildebrandt, H.W. Mueller, H. Stracke, Z.M. Rap, N. Klung, Different types of postoperative diabetes insipidus and the relation to basal and stimulated serum prolactin levels in patients with hypothalamo-hypophyseal tumorous lesions. Acta Neurochir. 104, 110–120 (1990). https://​doi.​org/​10.​1007/​BF01842828CrossRefPubMed
26.
go back to reference M. Araujo-Castro, F. Mariño-Sánchez, A. Acitores Cancela, A. García Fernández, S. García Duque, V. Rodríguez Berrocal, Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries. J. Endocrinol. Invest 44, 1457–1464 (2021). https://doi.org/10.1007/s40618-020-01448-6CrossRefPubMed M. Araujo-Castro, F. Mariño-Sánchez, A. Acitores Cancela, A. García Fernández, S. García Duque, V. Rodríguez Berrocal, Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries. J. Endocrinol. Invest 44, 1457–1464 (2021). https://​doi.​org/​10.​1007/​s40618-020-01448-6CrossRefPubMed
29.
go back to reference R.S. Joshi, M.P. Pereira, R.C. Osorio, T. Oh, A.F. Haddad, K.M. Pereira, K.C. Donohue, Z. Peeran, S. Sundhir, S. Jain, A. Beniwal, A. Chandra, S.J. Han, J.D. Rolston, P.V. Theodosopoulos, S. Kunwar, L.S. Blevins Jr, M.K. Aghi, Identifying risk factors for postoperative diabetes insipidus in more than 2500 patients undergoidng transsphenoidal surgery: a single-institution experience. J. Neurosurg. 137, 647–657 (2022). https://doi.org/10.3171/2021.11,JSN211260CrossRef R.S. Joshi, M.P. Pereira, R.C. Osorio, T. Oh, A.F. Haddad, K.M. Pereira, K.C. Donohue, Z. Peeran, S. Sundhir, S. Jain, A. Beniwal, A. Chandra, S.J. Han, J.D. Rolston, P.V. Theodosopoulos, S. Kunwar, L.S. Blevins Jr, M.K. Aghi, Identifying risk factors for postoperative diabetes insipidus in more than 2500 patients undergoidng transsphenoidal surgery: a single-institution experience. J. Neurosurg. 137, 647–657 (2022). https://​doi.​org/​10.​3171/​2021.​11,JSN211260CrossRef
31.
go back to reference M.E. Yasuda, D. Renedo, S. Sosa, K. Danilowicz, R. Recalde, R. Zaninovich, G. Abbati, A. Cervio, S. Giovannini, J. Villalonga, L. Ulloque-Caamaño, K. Reddy, M. Socolovsky, A. Campero, Risk factors related to transient diabetes insipidus development following transsphenoidal pituitary adenoma resection: A multicentric study. World Neurosurg. 175, e636–e643 (2023). https://doi.org/10.1016/j.wneu.2023.03.150CrossRefPubMed M.E. Yasuda, D. Renedo, S. Sosa, K. Danilowicz, R. Recalde, R. Zaninovich, G. Abbati, A. Cervio, S. Giovannini, J. Villalonga, L. Ulloque-Caamaño, K. Reddy, M. Socolovsky, A. Campero, Risk factors related to transient diabetes insipidus development following transsphenoidal pituitary adenoma resection: A multicentric study. World Neurosurg. 175, e636–e643 (2023). https://​doi.​org/​10.​1016/​j.​wneu.​2023.​03.​150CrossRefPubMed
37.
go back to reference M. Tanji, Y. Mineharu, M. Kikuchi, T. Nakagawa, T. Sakamoto, M. Yamashita, M. Matsunaga, F. Kuwata, Y. Kitada, Y. Terada, Y. Arakawa, K. Yoshida, H. Kataoka, S. Miyamoto, Intraoperative cerebrospinal fluid leak graded by Esposito grade is a predictor for diabetes insipidus after endoscopic endonasal pituitary adenoma resection. World Neurosurg. 158, e896–e902 (2022). https://doi.org/10.1016/j.wneu.2021.11.090CrossRefPubMed M. Tanji, Y. Mineharu, M. Kikuchi, T. Nakagawa, T. Sakamoto, M. Yamashita, M. Matsunaga, F. Kuwata, Y. Kitada, Y. Terada, Y. Arakawa, K. Yoshida, H. Kataoka, S. Miyamoto, Intraoperative cerebrospinal fluid leak graded by Esposito grade is a predictor for diabetes insipidus after endoscopic endonasal pituitary adenoma resection. World Neurosurg. 158, e896–e902 (2022). https://​doi.​org/​10.​1016/​j.​wneu.​2021.​11.​090CrossRefPubMed
39.
go back to reference A.N. Hoang, B.G. McGahan, S. Cua, S.T. Magill, P. Nayak, A.S. Montaser, L. Ghalib, L.M. Prevedello, D.A. Hardesty, R.L. Carrau, D.M. Prevedello, Pituitary stalk stretch predicts postoperative diabetes insipidus after pituitary macroadenoma transsphenoidal resection. Oper. Neurosurg. 24, 248–255 (2023). https://doi.org/10.1227/ons.0000000000000501CrossRef A.N. Hoang, B.G. McGahan, S. Cua, S.T. Magill, P. Nayak, A.S. Montaser, L. Ghalib, L.M. Prevedello, D.A. Hardesty, R.L. Carrau, D.M. Prevedello, Pituitary stalk stretch predicts postoperative diabetes insipidus after pituitary macroadenoma transsphenoidal resection. Oper. Neurosurg. 24, 248–255 (2023). https://​doi.​org/​10.​1227/​ons.​0000000000000501​CrossRef
Metadata
Title
Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery
Authors
Kiyohiko Sakata
Aya Hashimoto
Nobuyuki Takeshige
Kimihiko Orito
Ayako Nagayama
Kenji Ashida
Masatoshi Nomura
Motohiro Morioka
Publication date
25-04-2024
Publisher
Springer US
Published in
Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-024-03835-y
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare