垂体影像学特征在无功能性垂体腺瘤术后内分泌功能评估中的作用

Application of MRI features of pituitary to prediction of the endocrine function of patients with nonfunctional pituitary adenoma after endoscopic transsphenoidal surgery

目的探讨垂体影像学特征在无功能性垂体腺瘤(NFPA)术后内分泌功能评估中的作用。方法回顾性分析2010年3月~2021年3月经鼻蝶入路神经内镜手术切除的96例NFPA的临床资料。术前、术后2个月、术后12个月评估激素功能。结果术前54例(56.3%)出现垂体功能减退,术后2、12个月分别有67例(69.8%)和55例(57.3%)存在垂体功能减退。与术前相比,术后2、12个月,性腺功能减退、甲状腺功能减退、生长激素缺乏无明显变化(P>0.05),高泌乳素血症明显减少(P<0.05),但是肾上腺皮质功能减退、尿崩症术后2个月明显增加(P<0.05)、术后12个月又明显减少(P<0.05)。19例(19.8%)术后12个月出现少一个激素轴功能恶化。单因素分析显示,术前垂体柄是否可见与术后垂体功能恶化无明显关系(P>0.05),术前垂体腺可见程度、肿瘤切除程度、肿瘤体积与术后激素恶化有关(P<0.05)。多因素logistic回归分析显示术前垂体腺不可见是术后激素恶化的独立影响因素(P<0.05)。结论垂体功能减退是NFPA常见的临床表现,术前垂体功能评估具有重要意义。术后垂体激素轴可能恶化,垂体影像学特征,例如垂体腺可见程度、肿瘤大小等,可作为术后垂体功能恶化的评估指标。

Objective To investigate the value of pituitary imaging features in the assessment of endocrine function of the patients with nonfunctional pituitary adenoma(NFPA)after endoscopic transsphenoidal surgery(ETS).Methods The clinical data of 96 patients with NFPA who underwent ETS from March 2010 to March 2021 were retrospectively analyzed.Endocrine function was assessed before surgery,2 months and 12 months after surgery.Results Hypopituitarism occurred in 54 patients(56.3%)before operation,and in 67 patients(69.8%)and 55 patients(57.3%)2 and 12 months after operation,respectively.Compared with before operation,there were no significant changes in hypogonadism,hypothyroidism,and growth hormone deficiency 2 and 12 months after operation(P>0.05),and hyperprolactinemia was significantly reduced(P<0.05).Hypoadrenocorticism and diabetes insipidus increased significantly 2 months after operation(P<0.05),and decreased significantly 12 months after operation(P<0.05).Endocrine function deterioration,with one less hormonal axis functional deterioration 12 months after surgery,occurred in 19 patients(19.8%).Univariate analysis showed that preoperative pituitary gland visibility,tumor resection,and tumor volume were associated with postoperative hormonal deterioration(P<0.05),but the visibility of the pituitary stalk was not significantly related to the deterioration of pituitary function after surgery(P>0.05).Multivariate logistic regression analysis showed that absence of pituitary gland on preoperative MRI was an independent risk factor for postoperative hormonal deterioration(P<0.05).Conclusions Hypopituitarism is a common clinical manifestation of patients with NFPA,and preoperative assessment of pituitary function is of great significance.The pituitary hormone axis may deteriorate after NFPA.Preoperative pituitary imaging features,such as the visibility of the pituitary gland and tumor size,can be used as evaluation indicators for the deterioration of pituitary function after surgery.