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

Eur J Endocrinol. 2021 Apr;184(4):617-625. doi: 10.1530/EJE-20-1310.

Abstract

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.

MeSH terms

  • Adolescent
  • Age of Onset
  • Case-Control Studies
  • Child
  • China / epidemiology
  • Female
  • Follicle Stimulating Hormone / blood
  • Follow-Up Studies
  • Gonads / physiology*
  • Humans
  • Hypothalamo-Hypophyseal System / physiology*
  • Hypothalamus / physiology
  • Luteinizing Hormone / blood
  • Male
  • Neoplasms, Germ Cell and Embryonal / diagnosis
  • Neoplasms, Germ Cell and Embryonal / epidemiology
  • Neoplasms, Germ Cell and Embryonal / rehabilitation
  • Neoplasms, Germ Cell and Embryonal / therapy*
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / epidemiology
  • Pituitary Neoplasms / rehabilitation
  • Pituitary Neoplasms / therapy*
  • Prognosis
  • Puberty / blood
  • Puberty / physiology
  • Recovery of Function / physiology*
  • Retrospective Studies
  • Testosterone / blood

Substances

  • Testosterone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone