Clinical And Pathological Features Of 416 Patients With Pituitary Adenoma Were Analyzed

Objective:To analyze the distribution characteristics of general data,hormone levels and pathological types of 416 patients with pituitary adenoma surgery,and to improve clinicians ’ understanding of pituitary adenoma.Methods:Retrospective analysis of the clinical and pathological data of 416 patients who underwent pituitary adenoma surgery in Shanxi Provincial People ’s Hospital from January 1,2019 to December 31,2021 and underwent sellar enhanced magnetic resonance imaging before surgery in our hospital.The distribution characteristics and risk factors of invasive pituitary adenomas were analyzed.Results:1.General data distribution : 416 patients with pituitary adenoma treated by surgery,male to female ratio 225 : 191;gonadotropin cell adenoma accounted for the largest proportion of 64.66 %(269 / 416),followed by PRL cell adenoma and GH cell adenoma in 37 cases,double / multiple hormone cell adenoma in 34 cases,ACTH cell adenoma in 28 cases,null cell adenoma in 8 cases,TSH cell adenoma in only 3 cases.The age of patients is more common in 40-60 years old,among which null cell adenoma is the oldest.The clinical manifestations of acromegaly in patients with GH cell adenoma are the most common.Double / multi-hormone cell adenomas often have the symptoms of adenoma compression and acromegaly.The remaining types of adenomas are mostly due to dizziness,headache,vision loss and other mass effects.2.There were 273 patients(65.64 %)who completed the determination of 6hormones in the anterior pituitary before operation,and 119 patients(28.60 %)after operation.The preoperative hormone levels of PRL cell adenoma,GH cell adenoma,ACTH cell adenoma and TSH cell adenoma were mainly increased by PRL,GH,ACTH and TSH,respectively.In 21 cases of double / multiple hormone cell adenoma,GH(13cases)and PRL(5 cases)were more common,and the rest were ACTH,TSH and FSH.In addition to PRL cell adenomas,a variety of pituitary adenomas will have elevated PRL before surgery,and most of them are confirmed as gonadotropin cell adenomas after surgery,but the PRL level is mostly < 50 ng / ml,and the PRL level of different types of adenomas is statistically significant(P < 0.05).The Kappa values of PRL cell adenoma,TSH cell adenoma,GH cell adenoma,ACTH cell adenoma,double / multiple hormone cell adenoma and gonadotropin cell adenoma were 0.752,0.664,0.498,0.387,0.178 and0.031,respectively(all P < 0.05).3.The application of transcription factors reduced the proportion of null cell adenomas to 1.92 %(8 / 416);there were 269 cases of gonadotropin cell lineage,77 cases of eosinophil cell lineage and 28 cases of adrenocorticotropic hormone cell lineage(except 34 cases of bi / multi-hormone cell adenoma and 8 cases of null cell adenoma),respectively.The age of patients with gonadotropin cell lineage was the oldest.There were statistically significant differences in gender composition,P53 positive or not,endocrine-related clinical symptoms and hormone immunohistochemical staining among the three lineages(all P1 transcription factor positive pituitary adenoma comparison,≤ 1transcription factor positive adenoma patients were older,gender composition and endocrine-related clinical symptoms were statistically significant(all P < 0.05).4.Invasive risk factors : One-way analysis of variance showed that there were significant differences in the maximum diameter and the number of positive transcription factors between invasive and non-invasive pituitary adenomas(P1 transcription factor positive was a risk factor for invasiveness of pituitary adenomas.There were no significant differences in age,BMI,gender composition,Ki-67 index,P53 positive,hormone immunohistochemistry positive,endocrine-related clinical symptoms and adenoma types between invasive and non-invasive adenomas.Conclusion:1.Pituitary adenomas treated by surgery were more common in men than in women.Gonadotropin cell adenomas accounted for the largest proportion.The most common age group was 40-60 years old,and patients with null cell adenomas were the oldest.The clinical manifestations of GH cell adenoma are most common in acromegaly,and the other types of pituitary adenomas are mostly dizziness,headache,decreased vision,and visual field defects.2.Preoperative and postoperative pituitary hormone assessment is not comprehensive,especially after not enough attention;the preoperative hormone level of PRL cell adenoma is the best consistent with the postoperative pathological diagnosis.Hyperprolactinemia is also seen in non-PRL cell adenoma,but most of its prolactin levels are mild to moderate.3.The introduction of transcription factors reduces the proportion of null cell adenomas;patients with gonadotropin cell lineage in the three lineages were older.Compared with > 1 transcription factor positive pituitary adenoma,patients with ≤ 1transcription factor positive adenoma were older.4.Larger maximum diameter and > 1 transcription factor positive were independent risk factors for invasiveness of pituitary adenomas.There was no significant correlation between Ki-67 index and invasiveness.