SUN-081 - Endocrine Disturbances in Suprasellar Meningiomas and the Effect of Surgical Treatment: Experience with 275 Patients

INTRODUCTION. Meningiomas are relatively common, benign, slow-growing tumors. However, meningiomas of the suprasellar region (planum sphenoidale or tuberculum sellae meningiomas) account for only 5-10% of all intracranial meningiomas. Clinical presentation is highly variable and endocrine disturbances are considered uncommon. The aim of our study was to evaluate the preoperative hormonal status in patients with suprasellar meningiomas and to assess the impact of surgical resection on hypothalamic-pituitary axis function.

MATERIALS AND METHODS. We reviewed and retrospectively analyzed reports of 287 patients (219 women and 68 men; mean age 55.2  12.8 years) who underwent microsurgical resection of suprasellar meningiomas between 1982 and 2022 in our department.

RESULTS. The most frequent preoperative endocrine abnormality was hyperprolactinemia (14.7%). 7 to 12 days after surgery, an increased number (18.5%) of patients presented with hyperprolactinemia which settled at just 12.8% at delayed follow-up, approximately 3 months postoperatively. Preoperative corticotropic insufficiency was present in 3.2%. Postoperative deterioration occurred transiently in 24% but normalized in most cases by the delayed follow-up, with only 5.6% remaining affected. A low IGF-1 was preoperatively observed in 6 patients (3.9%). There was no change in IGF-1 (which was only available in a fraction of patients) over time. Subclinical hyperthyroidism was detected in 7.2% of the patients, subclinical hypothyroidism in 4.5% and overt hypothyroidism in only 1 patient preoperatively. At the second follow-up, subclinical hypothyroidism was present in 9.9% of patients, while thyroid function remained otherwise stable. Reduced testosterone levels were found in 5 male patients (17.9%) preoperatively, increased to 24 patients (85.7%) at first follow-up and improved to baseline levels in all but 5 patients at second follow-up. In postmenopausal women, hypogonadism was present preoperatively in 13 patients (24.1%) increased to 19 patients (35.2%) postoperatively and persisted in only 8 patients (14.8%). Surgical treatment was performed via the transcranial approach in 275 (95.8%) and via the transsphenoidal approach in 12 patients (4.2%). Mean tumor volume was 8.1 cm3  12.8 cm3. Gross total resection was achieved in 63.3% (n=174), and subtotal resection in 36.7% (n=113).

CONCLUSIONS. Endocrine disturbances in suprasellar meningiomas are rare. In the first postoperative follow-up endocrine dysfunctions frequently worsened, however, overall, endocrine dysfunctions improved or remained stable following surgical decompression. Tumor location and the growth pattern of these tumors render the transcranial approach more suitable for achieving gross total resection.

This study was supported by a grant of the Förderverein Neurochirurgische Forschung an der Universität Erlangen-Nürnberg e.V.

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