Nasrin Al-Shamkhi: Nonfunctioning pituitary adenoma–clinical outcome and prognostic factors

Abstract

Nonfunctioning pituitary adenomas (NFPA) are benign lesions that do not give rise to clinically excessive levels of pituitary hormones; on the contrary, they can cause pituitary deficiency. Due to the close anatomical relationship between the pituitary gland and the optic chiasm, visual disturbances do also occur. The clinical presentation and outcome of NFPAs are diverse.

In this thesis, the aim was to shed further light on clinical outcome, including how the patients experience their quality of life, after surgery due to NFPA and any prognostic factors.

In Paper I, a registry-based study, there was a significant increase in anterior pituitary deficiency at one year postoperatively compared to preoperatively. Even though only significant for the TSH axis, changes in the hormonal function of the anterior pituitary axes continued to occur between one and five years postoperatively.

In Paper II, all pituitary tumours were classified according to the World Health Organization’s classification, which includes transcription factor analysis. Binary logistic regression showed that in addition to older age at time of surgery and larger preoperative tumour volume, having a silent corticotroph tumour (SCT) was associated with an increased likelihood of postoperative pituitary deficiency compared to a silent gonadotroph tumour.

In Paper III, patients were interviewed about their quality of life and view on the healthcare they had received. By inductive content analysis a main theme, Life has changed but not necessarily for the worse, and the subthemes: The knowledge about the tumour evoked existential concerns, Suffering became a part of life, and Finding comfort in a new everyday life were identified.

In conclusion, there is reason to be aware of late changes in pituitary function, even when radiotherapy treatment has not been used, and SCT patients might benefit from more frequent hormonal evaluations. Additionally, NFPA patients declared that the diagnosis and its treatment had affected them, tempering aspects were also recognised. Overall, the participants’ expectations and experiences were influenced by the communication between them and the healthcare providers.

To unveil the implications of NFPAs, prospective studies with harmonised definitions of deficiency in each pituitary axis, long enough postoperative follow-up time, and correct classification of NFPA type are needed. Besides that, to capture the patients’ perspectives more studies with a qualitative methodology are needed; hence, qualitative methodology allows one to move beyond the clinicians’ perspective.