The Relationship Study Of Hormone Levels With Surgical Effects Of Functional Pituitary Adenomas

ObjectiveThrough evaluating the relationships between preoperative serum hormone levels and invasiveness of tumors and surgical effects, and assessing the relationships between postoperative early serum hormone levels and long-term results of patients with functional pituitary adenomas, to discuss predictors of long-term remission of patients with functional pituitary adenomas and provide evidences on further therapeutic strategies for postoperative patients.Materials and MethodsWe collected and analyzed 547 initial treated cases of patients with functional pituitary adenomas. All patients were performed hormonal assessment in the next morning in hospital and within the first 7 days following surgery. There were 358 patients with prolactinomas, 119 with somatotropinomas, 46 with corticotropinomas, 4 with thyrotropinomas, 20 with mixed adenomas. The invasiveness of pituitary adenomas were judged from neuroradiographic and intraoperative findings of the degree of sellar destruction and suprasellar extension, according to Hardy' classification scheme modified by Wilson. There were 223 patients with invasive pituitary adenomas, and 324 patients with noninvasive pituitary adenomas. All patients received microsurgical treatment, and obtained follow-up datas for 364 patients. Cure was defined as normalization of hormonal levels, disappearence of clinic symptoms, and no recurrence in follow-up period. Remission was defined that clinic symptoms were sharply improved, and hormonal levels normalized or reduced above 50%. Persistence was defined that hormonal levels reduced less 50%, and clinic symptoms werenot improved. A recurrence was defined as an initial remission followed by a rise in the hormone levels and recurrent symptoms.Results:1. There were 358 patients with PRL-secreting pituitary adenomas, 149 patients with invasive adenomas, and 209 patients with noninvasive adenomas. The average serum prolactin level of patients with invasive adenomas(217. 4 + 291. 5ug/L)was significantly higher than that of patients with noninvasive adenomas (128. 3+104. 7ug/U P<0. 01). The occurrence rate of invasive adenomas of patients with PRL values of >200ug/L(56.4%) was significantly higher than that of patients with PRL values of^l00ug/L and 100-200ug/L(24% and 41%, P<0.001 and P<0.05). Logistic regression analysis indicated that the incidence of invasive adenomas in patients with PRL values of >200ug/L was 4. 095 times higher than that of patients with PRL values of <1OOug/L. There were 237 patients who experenced postoperative remission. The remission rates of patients with microadenomas (<1cm) and noninvasive macroadenomas (>1cm) were 90% and 80.8%, which were significantly higher than patients with invasive adenomas (38. 9%, P<0. 0001). The postoperative remission rate of patients with PRL values of >200ug/L(37. 6%) was significantly lower than those of <1OOug/L and 100-200ug/L(91. 7% and 75. 2%, P<0. 0001). The long-term remission rate of patients with early postoperative PRL values of <10ug/L(94%) was significantly higher than that of patients with early postoperative PRL values of 10-20ug/L, 20-30ug/L and >30ug/L(77. 8%, 70% and 48. 8%, P<0. 05).2. There were 119 patients with GH-secreting pituitary adenomas, 50with invasive adenomas, and 69 with noninvasive adenomas. The averageserum growth hormone level of patients with invasive adenomas(75. 6+34. 1ug/L) was significantly higher than that of patients withnoninvasive adenomas (37. 4 + 10. 6ug/L, P<0. 01) . The occurrence rate of invasive adenomas of patients with GH values of >50ug/L(66.7%) was significantly higher than that of other groups(P<0.05). Logistic regression analysis indicated that the occurrence rate of invasive adenomas of patients with GH values of >50ug/L was 4. 674 times higher than that of patients with GH values of <50ug/L. There were 78 patients achieved in postoperative remission. The remission rates of patients with microadenomas and noninvasive macroadenomas were 92. 6% and 83. 3%, which were significantly higher than that of pat...