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

in European Journal of Endocrinology
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  • 1 K Zhang, Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
  • 2 L Wang, Endocrinology, Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing, China
  • 3 L Duan, Key Laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
  • 4 H Yang, Endocrinology, Peking Union Medical College Hospital, Beijing, 100730, China
  • 5 H Pan, Endocrinology, Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Beijing, China
  • 6 X Lian, Department of Radiotherapy, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, China
  • 7 Y Yao, Department of Neurosurgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  • 8 H Zhu, Endocrinology, Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, 2Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China, Beijing, 100730, China

Correspondence: Huijuan Zhu, Email: shengxin2004@163.com
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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 127 suprasellar GCT patients, 75 met the follow-up criteria, and 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% confidence interval (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

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