Nonfonksiyonel hipofiz adenomu nedeniyle opere edilen hastaların değerlendirilmesi; postoperatif klinik gidişi etkileyen faktörler
Evalutaion of patients operated non-functional pituitary adenoma; factors affecting postoperative clinical course
Yazar: MERVE OKUYUCU
Danışman: PROF. DR. BERRİN ARSLAN
Kocaeli Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı / İç Hastalıkları Bilim Dalı
Derece: Tıpta Uzmanlık, 2024
Konu: İç Hastalıkları = Internal diseases
Dizin: Reseptörler-hipofiz hormonları = Receptors-pituitary hormone

Özet:
Amaç: Nonfonksiyone hipofiz adenom (NFHA) sebepli opere olan hastaların
postoperatif prognozlarını etkileyebilecek faktörlerin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmamıza 01.08.2018 ile 30.10.2023 arasında makroadenom
sebepli opere edilen ve/veya dış merkezde NFHA sebepli opere edildikten sonra nüks
sebepli hastanemize başvurusu neticesinde reopere olan, dahil etme ve dışlama
kriterlerimize uyan bütün NFHA hastaları dahil edilmiştir. Çalışmaya dahil edilen
tüm hastaların demografik bilgileri, preoperatif ve postoperatif hormon
parametreleri, klinik bulguları, radyolojik görüntüleri, patoloji sonuçları retrospektif
olarak incelenmiştir.
Bulgular: Hastaların %40,9'u kadın, %59,1'i erkekti. Ortalama yaş 50.1±11.6 idi.
Hastaların %24,4'ü insidental tanı alırken, %75,6'sı semptomatik tanı almıştı.
Hastaların sadece %1'inde mikroadenom izlendi. Preopertif izole hormon eksikliği
%27,5; panhipopitüitarizm %14,1 ve apopleksi %2,3 olarak belirlendi. İzole hormon eksikliği içinde hipogonadizm en sık ön hipofiz disfonksiyonu olarak saptandı.
Panhipopitüitarizm varlığında nüks oranı %29,1 ile istatiksel anlamlı bulunmuştur
(p=0.021). Kalıcı ön hipofiz disfonksiyonu kadınlarda %23,9, erkeklerde %61,7
saptandı (p<0.001). Preoperatif panhipopitüitarizm olanlarda postoperatif kalıcı ön
hipofiz disfonksiyonu oranı %90,9 olarak bulundu (p<0.001). Kalıcı diyabetes
insipidus gelişiminde apopleksinin predispozan faktör olduğu tespit edildi (p=0.043).
Sonuç: Tıpta modernleşmeyle birlikte NFHA tespit oranları giderek artmaktadır.
Saptanan NFHA'ları genellikle makroadenom boyutuna ulaştığında tespit edilmekte
olup bu da beraberinde ek hormon eksiklikleri ve riskler getirmektedir. Semptomların
iyi irdelenmesi adenomların daha erken dönemde tespit edilmesini sağlayabilir ve
olası riskleri azaltabilir.
Anahtar Kelimeler: hipofiz, nonfonksiyonel hipofiz adenomu, nüks, sınıflandırma,
diyabetes insipidus

Abstract:
Objective: To determine the factors that may affect the postoperative prognosis of
patients operated for nonfunctioning pituitary adenoma. The predictive factors for
NFPA recurrence, persistent anterior pituitary dysfunction and persistent diabetes
insipidus, which are conditions that may lead to the risk of reoperation, quality of life
and drug dependence, were analyzed.
Materials and Methods: Our study included all patients with non functioning
pituitary adenoma who were operated on for macroadenoma at Kocaeli University
Medical Faculty Hospital between 01.08.2018 and 30.10.2023 and/oroperated on for
NFPA at an external center and reoperated to our hospital for recurrence, and who
met our inclusion and exclusion criteria. Demographic data, preoperative and
postoperative hormone parameters, clinical findings, radiologic images and
pathology results of all patients included in the study were retrospectively analyzed.
In the light of the data obtained, all factors that may contribute to the development of
recurrence, permanent diabetes insipidus and permanent anterior pituitary
dysfunction in the post operative period were comparatively statistically analyzed.
Results: 40,9% of the patients were female and 59,1% were male. While 23,1% were
under 40 years of age, 76,9% were over 40 years of age with a mean age of
50.1±11.6 years. While 24,4% of thepatients had an incidental diagnosis, 75,6% had
a symptomatic diagnosis. According to adenoma size, 87,1% had <4 cm
macroadenoma, 11,8% had >4 cm macroadenoma and 1% had microadenoma.
Isolated hormoned eficiency was 27,5%, preoperatiferative panhypopituitarism was
14,1% and apoplexy was 2,3%. Among those with isolated hormoned eficiency,
hypogonadism was the highest anterior pituitary dysfunction with 67,4%. The rate of
patients with hyperprolactinemia was 22,3%. In our study, the
recurrence rate in the presence of panhypopituitarism was statistically significant
with 29,1% (p=0.021). However, nosignificant effect on recurrence was found
among patients with pathologic NFPA subtyping. In gender distribution, the rate of
persistent anterior pituitary dysfunction was 23.9% in women and 61.7% in men and
was significantly lower in women (p<0.001). In the presence of preoperative
panhypopituitarism, the rate of permanent anterior pituitary dysfunction was 90.9%,
which was statistically significant (p<0.001). Pathologically, nopermanent anterior
pituitary dysfunction was observed in any of our patients diagnosed with
somatotroph tumor (p=0.022). Apoplexy was found to be a predisposing factor in the
development of permanent diabetes insipidus (p=0.043), while none of the patients
diagnosed with lactotroph adenoma developed DI (p=0.018).
Conclusion: Determining the sensitivity and specificity of symptoms, clinical
findings and pathologic subtyping in predicting the rates of recurrence, persistent
diabetes insipidus, and persistent anterior pituitary dysfunction after nonfunctioning
pituitary adenoma surgery will make patient follow up more cost effective and safer.
Ourstudy is a retrospective study and immuno histochemical classification result data
of all patient scould not be obtained due to the conditions of the pathology
laboratory. This is a limiting factor in our study. Therefore, prospective, well-planned
and multicenter studies are needed.
Keywords: pituitary, nonfunctional adenoma, recurrence, classification, diabetes
insipidus