Analysis Of The Low Level Of Hormone After The Operation Of Nonfunctional Pituitary Tumor By Transsphenoidal Approach Under Microscope

OBJECTIVE: The incidence of low hormone level after transsphenoidal nonfunctional pituitary adenoma operation is high.It is of great clinical significance to explore the risk factors of low hormone level after operation.METHODS: The clinical data of 112 patients with nonfunctional pituitary adenoma under the microscope from January 1,2017 to December 31,2018 in the First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively.Using spss19.0 statistical software,chi square test and logistic regression analysis model,the data were statistically analyzed to explore the statistical differences of sex,age,tumor volume,square root,preoperative hormone level,invasion of cavernous sinus,hematocele,tumor residue,tumor texture,cerebrospinal fluid leakage,intracranial infection and other factors with low hormone level one year after operation.P < 0.05 was statistically significant.RESULTS: Among 112 cases of nonfunctional pituitary adenoma,50 cases were female(44.6%),62 cases were male(55.4%);female: male = 0.81:1.0.The age range was 16-77 years old,among which 4 cases were younger than 18 years old,accounting for 3.6%;80 cases were 18-50 years old,accounting for71.4%;28 cases were older than 50 years,accounting for 25%.The preoperative hormone level was low in 56 cases(50.0%)and normal in 56 cases(50.0%).The hormone level was low in 53 cases(47.3%)and normal in 59 cases(52.7%).The clinical course of the patients ranged from 3 days to 15 months,with an average of 3.6 months.The main complaints included 22 cases of asthenia(19.6%),9cases of examination(8.0%),2 cases of growth disorder(1.7%),36 cases of vision decline and visual field loss(32.1%),35 cases of headache and dizziness(31.2%),5 cases of hyposexual desire(4.5%),3 cases of menstrual disorder(2.7%).The results of single factor analysis were statistically significant(P <0.001,P < 0.001,P < 0.035).There was no significant difference in sex,texture,cavernous sinus invasion,postoperative hematocele,CSF leakage and intracranial infection(P = 0.801,0.757,0.706,0.435,0.790,0.431,respectively).Further logistic regression analysis showed that preoperative hypohormone and tumor volume square root were independent factors of postoperative hypohormone(or value of preoperative hypohormone was 4.663,P value was0.023;or value of tumor volume square root was 2.357,P value was 0.035,95%CI was(0.838,4.532))CONCLUSION: 1.the proportion of male to female patients with nonfunctioning pituitary adenomas was basically the same.The highest incidence rate was 18 to 50 years of age.Visual field impairment,headache and fatigue were the most common symptoms.Preoperative hormone levels were about half of the total.2.Age,tumor volume,low preoperative hormone level are related to low postoperative hormone level.Low preoperative hormone level and tumor volume square root are independent factors for the occurrence of low postoperative hormone level in nonfunctional pituitary adenomas.Patients with nonfunctional pituitary adenoma should be diagnosed as early as possible,and long-term hormone replacement therapy should be emphasized for patients with low preoperative hormone level and large tumor volume.