Hormone outcomes following endoscopic endonasal resection of nonfunctional pituitary adenomas.

More than half of NFPA patients presented with preoperative hormone deficiency, and nearly half required permanent postoperative hormone replacement.

• Cohort included 372 patients treated between 2006 and 2023 at Weill Cornell Medicine.
• 56% of patients presented with preoperative hormone deficiency of at least one axis.
• Postoperatively, 178 patients (48%) required permanent hormone replacement for at least one hormonal axis.
• 79% of patients underwent gross-total or near-total resection.

The most common axis requiring permanent postoperative hormone replacement was thyroid, followed by cortisol, gonadotropin, and antidiuretic hormone.

• Thyroid replacement was required permanently in 34% of patients.
• Cortisol replacement was required permanently in 23% of patients.
• Gonadotropin replacement was required permanently in 15% of patients.
• Antidiuretic hormone replacement was required permanently in 7% of patients.

Nearly one-third of patients with no preoperative endocrinopathy developed new permanent hormone replacement requirements after surgery.

• 30.8% of patients with no preoperative endocrinopathy needed new hormone replacement therapy postoperatively.
• Tumor size was a strong predictor: if the tumor was < 2 cm, 23.5% needed new hormone replacement.
• If the tumor was > 3 cm, 54.5% needed new hormone replacement.
• Apoplexy was identified as a strong predictor of hormone deterioration.

A substantial proportion of patients with preoperative hormone deficiency experienced improvement and did not require long-term replacement after surgery.

• 39.5% of patients with a preoperative hormone deficiency did not require any long-term replacement postoperatively.
• For tumors < 2 cm, 53.3% of patients with preoperative deficiency improved.
• For tumors > 3 cm, 32.7% of patients with preoperative deficiency improved.
• These findings highlight a 'balanced' rate of hormone loss and improvement after NFPA resection.

Tumor size and preoperative hormone status were strong predictors of postoperative hormone outcomes, with additional significant associations found for hemorrhage on MRI, age, and sex.

• Multivariable logistic regression analysis was used to identify predictors of hormone deterioration and improvement.
• Hemorrhage on MRI, age, and sex were significantly associated with permanent hormone replacement and improvement.
• The associated factors differed for each hormonal axis.
• Apoplexy was identified alongside tumor size as a strong predictor of outcome.

This was a retrospective single-institution study spanning nearly two decades with a large cohort of NFPA patients.

• Study was conducted at Weill Cornell Medicine between 2006 and 2023.
• 372 patients were included in the analysis.
• Data collected included demographics, preoperative hormone status, laboratory values, pathological and radiographic tumor characteristics, and postoperative transient and permanent hormone replacement.
• The study used multivariable logistic regression analysis to identify predictors.