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. 2015 Nov 5:5:16194.
doi: 10.1038/srep16194.

Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma

Cheng-Chi Lee  1   2 , Chung-Ming Chen  1 , Shih-Tseng Lee  2 , Kuo-Chen Wei  2 , Ping-Ching Pai  3 , Cheng-Hong Toh  4 , Chi-Cheng Chuang  2
Affiliations

Prediction of Long-term Post-operative Testosterone Replacement Requirement Based on the Pre-operative Tumor Volume and Testosterone Level in Pituitary Macroadenoma

Cheng-Chi Lee et al. Sci Rep. .

Abstract

Non-functioning pituitary macroadenomas (NFPAs) are the most prevalent pituitary macroadenomas. One common symptom of NFPA is hypogonadism, which may require long-term hormone replacement. This study was designed to clarify the association between the pre-operative tumor volume, pre-operative testosterone level, intraoperative resection status and the need of long-term post-operative testosterone replacement. Between 2004 and 2012, 45 male patients with NFPAs were enrolled in this prospective study. All patients underwent transsphenoidal surgery. Hypogonadism was defined as total serum testosterone levels of <2.4 ng/mL. The tumor volume was calculated based on the pre- and post-operative magnetic resonance images. We prescribed testosterone to patients with defined hypogonadism or clinical symptoms of hypogonadism. Hormone replacement for longer than 1 year was considered as long-term therapy. The need for long-term post-operative testosterone replacement was significantly associated with larger pre-operative tumor volume (p = 0.0067), and lower pre-operative testosterone level (p = 0.0101). There was no significant difference between the gross total tumor resection and subtotal resection groups (p = 0.1059). The pre-operative tumor volume and testosterone level impact post-operative hypogonadism. By measuring the tumor volume and the testosterone level and by performing adequate tumor resection, surgeons will be able to predict post-operative hypogonadism and the need for long-term hormone replacement.

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Figures

Figure 1
Figure 1
Scatter diagram showing that a larger pre-operative tumor volume negatively impacts the pre-operative serum level of testosterone, with a coefficient of −0.335 (p = 0.0151, adjusted R2 = 0.0946), based on the Pearson correlation coefficients method.
Figure 2
Figure 2
Patient 16 had a tumor that measured 33.51 cm3. It had invaded the paracavernous area; therefore, only partial removal could be achieved.
Figure 3
Figure 3. Most of the residual tumor resided in the paracavernous area, and the sella was extensively decompressed.
However, the patient required long-term testosterone replacement possibly due to the large tumor volume and its effect on the pituitary gland.
See this image and copyright information in PMC

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