| Background:Acromegaly is a rare progressive chronic disease that occurs due to elevated concentrations of growth hormone(GH)and insulin-like growth factor-1(IGF-1)in the blood.The most prominent clinical manifestations of acromegaly are enlargement of the joints in the hands,feet,and limbs,as well as changes in facial appearance.In addition,patients with acromegaly often have metabolic abnormalities,cardiovascular and respiratory and endocrine system disorders.The treatment goal of patients is to reduce excessive levels of GH and IGF-1 in the blood,mainly through surgical removal of pituitary tumors,supplemented by other treatment methods such as medical therapy or radiotherapy due to different patient requirements.There are currently few clinical studies on the effects of high GH levels in patients with acromegaly before and after surgery,as well as the space occupying effect of tumors,on the release of other anterior pituitary hormones and the pituitary target axis.Purpose:This large-sampled retrospective study focused on patients of Peking Union Medical College Hospital was designed to evaluate the relationship between characteristics of acromegaly and pituitary-organ axis both before and after transsphenoidal surgery.Methods:This was a single center,retrospective study.The relevant information and follow-up records of 652 patients with pituitary growth hormone adenoma admitted to neurosurgery department of Peking Union Medical College Hospital from January 2015 to December 2018 were collected and counted.Excel,SPSS,and Origin were used to analyze the collected data.Non-parametric tests,independent risk factor analysis,and ROC curve plotting were used to visualize and analyze data.Results:Mean diagnosed age(male 290,44%;female 362,55%):41.7±12.1 years,disease duration:76±68 months;microadenomas 114 cases(17%),macroadenomas 538 cases(83%).Invasion of cavernous sinus(Knosp grade Ⅲ and Ⅳ)218 cases(33%)and non-invasive(Knosp grade Ⅰ and Ⅱ)434 cases(67%).Mean random GH:34.8±74.9 ng/mL,mean serum IGF-1:852±262ng/mL.Percentage of pituitary-gonadal axis hypofunction in male patients preoperatively was 40.1%(101/252)and 15.1%postoperative(new onset:2.0%(4/199).remaining cases:13.1%(26/199)).Percentage of pituitary-gonadal axis hypofunction in female patients preoperatively was 49.2%(90/183)and 34.0%postoperatively(new onset:3.8%(4/199),remaining cases:32.0%(32/106)).Percentage of pituitary-thyroid axis hypofunction preoperatively was 6.1%(39/636)and 5.3%postoperatively(new onset:3.3%(17/509),remaining cases:2.0%(26/509)).Percentage of pituitary-adrenal axis hypofunction preoperatively was 5.2%(33/634)and 4.5%postoperatively(new onset:3.1%(15/489),remaining cases:1.4%(7/489)).Invasion of cavernous sinus(p =0.000)and preoperative PRL(p=0.001)were independent risk factors of androgen deficiency in male patients.Invasion of cavernous sinus was the best single factor to predict pituitary-gonadal axis hypofunction in male patients preoperatively.histological staining for prolactinoma(+)(p=0.001)and remission of acromegaly(p=0.022)were independent risk factors for low androgen levels in male patients during follow-up.Remission of acromegaly was the best single factor for pituitary-gonadal axis hypofunction in male patients postoperatively.The age of diagnosis(p<0.001),preoperative random GH(p=0.005)and preoperative nadir GH(p=0.022)were independent risk factors for menstrual disorders in women preoperatively.Age of diagnosis was the best single factor to predict pituitary-gonadal axis hypofunction in female patients preoperatively.BMI(p=0.045),Invasion of cavernous sinus invasion(p=0.028),compression of optic chiasm(p=0.001)and preoperative IGF-1(p<0.001)were independent risk factors for preoperative hypothyroidism.Compressions of optic chiasm was the best single factor to predict pituitary-thyroid axis hypofunction preoperatively.Conclusions:Percentage of preoperative hypofunction:female pituitary-gonadal axis>male pituitary-gonadal axis>pituitary-thyroid axis>pituitary-adrenal axis.Remission rate after TSS:male pituitary-gonadal axis>female pituitary-gonadal axis>pituitarythyroid axis>pituitary-adrenal axis. |
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