Recovery of hypothalamus–pituitary–gonadal dysfunction after the treatment of suprasellar germ cell tumors

in European Journal of Endocrinology
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  • 1 Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
  • 2 Department of Endocrinology, Shijiazhuang People’s Hospital, The People Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
  • 3 Department of Radiotherapy, Shijiazhuang People’s Hospital, The People Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
  • 4 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Correspondence should be addressed to H Zhu; Email: shengxin2004@163.com

*(K Zhang and L Wang contributed equally to this work)

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Objective

To investigate the incidence of hypothalamus–pituitary–gonadal (HPG) axis initiation/recovery after treatment and to identify predictive risk factors for noninitiation/recovery.

Methods

A total of 127 consecutive suprasellar germ cell tumor (GCT) patients managed at Peking Union Medical College Hospital (2006–2019) were retrospectively analyzed. Prepubertal patients (followed up until 13 years of age for girls and 14 years of age for boys) and patients with HPG dysfunction (followed up for 2 years) were divided into the initiation/recovery and noninitiation/recovery groups.

Results

Of the 127 suprasellar GCT patients, 75 met the follow-up criteria, 28 (37.3%) of whom experienced HPG axis initiation/recovery. Compared to the noninitiation/recovery group, the initiation/recovery group included more males and had shorter delayed diagnosis times, smaller tumor sizes, lower panhypopituitarism rates, thinner pituitary stalk widths, lower visual deficit rates, and higher serum testosterone and estradiol levels. The cutoff values of pituitary stalk width, tumor size, and delayed diagnosis time used to predict noninitiation/recovery were 6.9 mm, 6.9 mm and 1.7 years, respectively. Tumor size ≥6.9 mm (odds ratio (OR) = 7.5, 95% CI: 2.2–25.8, P = 0.001), panhypopituitarism (OR = 5.0, 95% CI: 1.4–17.6, P = 0.013), and delayed diagnosis time ≥1.7 years (OR = 5.7, 95% CI: 1.5–20.7, P = 0.009) were risk factors for noninitiation/recovery.

Conclusions

Among suprasellar GCT patients, nearly one-third of prepubertal patients and patients with HPG dysfunction experience HPG axis initiation/recovery after treatment. Tumor size ≥6.9 mm, panhypopituitarism, and delayed diagnosis time ≥1.7 years were identified as predictive risk factors for noninitiation/recovery.

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
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