Gonadotrop adenomlu hastalarda preoperatif ve postoperatif metabolik ve kardiyovasküler parametrelerin karşılaştırılması
Comparison of preoperative and postoperative metabolic and cardiovascular parameters in patients with gonadotroph adenoma
- Tez No: 963236
- Danışmanlar: DOÇ. DR. FATMA DİLEK KAHRAMANCA
- Tez Türü: Tıpta Uzmanlık
- Konular: Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2025
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Ankara Bilkent Şehir Hastanesi
- Ana Bilim Dalı: İç Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 123
Özet
Amaç: Hipofiz adenomları, primer beyin kitlelerinin %15'lik kısmını oluşturan iyi huylu tümörlerdir ve gelişen görüntüleme yöntemleri nedeniyle bu adenomların tanı sıklığı giderek artmaktadır. Adenomların bir kısmı, aşırı hormon salgısına neden olup buna bağlı semptomlara yol açarak tanı almaktayken, diğer kısmı ise kliniğe yol açmayacak düzeyde hormon salgısı yaparak veya hiç hormon salgısı yapmayarak (nonfonksiyone) sessiz kalmaktadır. Bu sessiz adenomlar genellikle kitle etkisine bağlı semptom ve bulgulara neden olarak tanı alabildikleri gibi, başka bir sebeple yapılan görüntüleme sırasında rastlantısal olarak ta tanı alabilmektedir. Gonadotrop adenomlar, hipofiz adenomlarının %15 ila %40'ını oluşturur. Çoğunlukla hormonları verimsiz şekilde üretip salgılamaları nedeniyle nonfonksiyone adenom kliniğinde seyrederler. Cerrahi olmaksızın kesin tanılarının konması zordur. Bu çalışmada gonadotrop adenom tanısı olan hastalarda kardiyometabolik risk faktörlerinin belirlenmesi, preoperatif ve postoperatif dönemdeki kardiometabolik parametrelerinin değerlendirilmesi ve karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bu gözlemsel retrospektif çalışmada 01.05.2019 ile 01.08.2024 tarihleri arasında Ankara Bilkent Şehir Hastanesi'nde endoskopik transsfenoidal yaklaşımla hipofiz adenom cerrahisi geçiren hastaların verilerine ulaşılarak, histokimyasal ve immunohistokimyasal yöntemlerle gonadotrop adenomu tanısı almış olan hastalar çalışmaya dahil edildi. Gebe,
Özet (Çeviri)
Objective: Pituitary adenomas are benign tumors that constitute approximately 15% of all primary intracranial masses, and their diagnostic frequency has been increasing with the advancement of imaging techniques. While some adenomas are diagnosed due to symptoms caused by excessive hormone secretion, others remain clinically silent by secreting minimal or no hormones at all, and are therefore referred to as nonfunctioning adenomas. These silent tumors may become symptomatic due to mass effect or may be detected incidentally during imaging performed for unrelated reasons. Gonadotroph adenomas account for approximately 15% to 40% of all pituitary adenomas. Since they often secrete hormones inefficiently, they typically present as nonfunctioning adenomas, making diagnosis without surgical intervention challenging. This study aimed to identify cardiometabolic risk factors in patients diagnosed with gonadotroph adenoma and to evaluate and compare their cardiometabolic parameters in the preoperative and postoperative periods. Materials and Methods: In this observational retrospective study, data were collected from patients who underwent pituitary adenoma surgery via endoscopic transsphenoidal approach at Ankara Bilkent City Hospital between May 1, 2019, and August 1, 2024. Patients diagnosed with gonadotroph adenoma based on histochemical and immunohistochemical findings were included. Pregnant individuals, patients under 18 years of age, and those with a history of prior pituitary surgery were excluded from the study. Demographic data of the included patients (age, sex, height, weight, body mass index [BMI], smoking status), reason for imaging, comorbid conditions at diagnosis (type 2 diabetes mellitus [DM], hypertension [HT], cardiovascular disease [CVD]), and preoperative and postoperative measurements of height, weight, systolic and diastolic blood pressure, glucose, creatinine, alanine aminotransferase [ALT], aspartate aminotransferase [AST], hemoglobin A1c [HbA1c], lipid panel (total cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides), pituitary hormones (adrenocorticotropic hormone [ACTH], cortisol, follicle-stimulating hormone [FSH], luteinizing hormone [LH], growth hormone [GH], prolactin [PRL]) and target hormones (free T3 [fT3], free T4 [fT4], estradiol, progesterone, total and free testosterone, insulin-like growth factor 1 [IGF-1]) were recorded. Additionally, pituitary magnetic resonance imaging (MRI) data were reviewed to determine lesion size, type, localization, and Knosp score. Histopathological and immunohistochemical results were obtained from pathology reports. Mortality data were collected from the hospital's electronic medical records and physical patient files. The postoperative follow-up period was calculated as the number of months between the date of surgery and the most recent outpatient visit. Data from the 6th and 12th postoperative months were retrieved to evaluate biochemical and hormonal parameters, the presence of type 2 DM, HT, and CVD, as well as the development of hypopituitarism. Using the collected data, the 10-year estimated cardiovascular risk was calculated using the Systematic Coronary Risk Estimation (SCORE-1, SCORE-2) and the Atherosclerotic Cardiovascular Disease (ASCVD) risk score recommended by the American College of Cardiology/American Heart Association (ACC/AHA). Preoperative, 6-month, and 12-month postoperative data were compared according to these risk categories. Results: Among the included patients, 37.2% were female and 62.8% were male, with a mean age of 55.8 ± 12.4 years. In the preoperative period, lesions with a Knosp score of 3–4 were observed significantly more frequently in male patients compared to female patients (p = 0.005). When evaluating cardiovascular risk scores in the preoperative period, 51.8% of patients were classified as high or very high risk according to the SCORE1 algorithm, 31.7% according to SCORE2, and 59.2% according to the ACC/AHA ASCVD risk calculator. A total of 63.7% of the patients had at least one chronic comorbidity. The most common comorbidities were hypertension (HT) (38.9%), type 2 diabetes mellitus (T2DM) (30.1%), and hyperlipidemia (21.2%). A positive family history of coronary artery disease (CAD) was present in 19 patients (16.8%). The median body mass index (BMI) was calculated as 29.1 kg/m². Among the 95 patients whose data could be evaluated, 31.6% met the criteria for metabolic syndrome. In the postoperative period, significant improvements were observed in patients' cardiometabolic risk profiles. There were statistically significant reductions in the 10-year cardiovascular risk scores calculated by SCORE1, SCORE2, and ACC/AHA ASCVD algorithms (all p < 0.001). Regarding the lipid profile, significant decreases were detected in total cholesterol, LDL-cholesterol, and triglyceride levels (all p < 0.001), while no significant change was observed in HDL-cholesterol levels (p = 0.06). A statistically significant reduction in HbA1c levels was also noted postoperatively (p < 0.001), which was significant in both diabetic and non-diabetic subgroups (p = 0.006 and p = 0.004, respectively). The frequency of adrenal insufficiency (p < 0.001), secondary hypothyroidism (p = 0.04), secondary hypogonadism (p < 0.001), and growth hormone deficiency (p < 0.001) decreased significantly in the postoperative period. There was a significant reduction in prolactin (PRL) levels after surgery (p < 0.001), while IGF-1 levels showed a significant increase (p = 0.02). Moreover, significant increases were observed in TSH (p = 0.004) and free T4 (sT4) levels (p = 0.003). In male patients, total testosterone levels significantly increased after surgery (p < 0.001). Conclusion: In patients with gonadotroph pituitary adenomas who underwent transsphenoidal surgery, significant improvements were observed not only in pituitary hormonal parameters but also in cardiovascular risk scores, lipid profiles, and HbA1c levels compared to the preoperative period. The surgical treatment of gonadotroph adenomas appears to have beneficial effects not only on hormonal balance but also on cardiometabolic health. Surgical intervention in appropriate patients may contribute to a reduction in cardiovascular disease risk.
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