Intrasellar Pressure is Related to Endocrine Disturbances in Patients with Pituitary Tumors

-OBJECTIVE: The aim of this study was to investigate the association between intraoperative intrasellar pressure (ISP) and pre-and postoperative endocrine disturbances with focus on hyperprolactinemia and hypopituitarism in patients with pituitary tumors.-METHODS: The study is a consecutive, retrospective study with ISP collected prospectively. One hundred pa-tients operated with transsphenoidal surgery due to a pi-tuitary tumor, who had their ISP measured intraoperatively, were included. Data on patient endocrine status preoper-atively and from 3-month postoperative follow-up were collected from medical records.-RESULTS: The risk of preoperative hyperprolactinemia in patients with nonprolactinoma pituitary tumors increased with ISP (unit odds ratio 1.067, n = 70) (P = 0.041). Pre-operative hyperprolactinemia was normalized at 3 months after surgery. Mean ISP was higher in patients with pre-operative thyroid-stimulating hormone (TSH) deficiency (25.3 + 9.2 mmHg, n = 37) than in patients with intact thyroid axis (21.6 + 7.2 mmHg, n = 50) (P = 0.041). No significant difference in ISP was found between patients with and without adrenocorticotropic hormone(ACTH) deficiency. No association was found between ISP and postoperative hypopituitarism at 3 months after surgery.-CONCLUSIONS: In patients with pituitary tumors, pre-operative hypothyroidism and hyperprolactinemia may be associated with higher ISP. This is in line with the theory of pituitary stalk compression, suggested to be mediated by an elevated ISP. ISP does not predict the risk of post-operative hypopituitarism 3 months after surgical treatment.