Endocrine Dysfunction And Hormonal Abnormalities In Patients With Pituitary Macroadenoma

Abstract

Background: Pituitary macroadenomas are clinically significant sellar lesions which can produce endocrine dysfunction by either hypersecretion of endocrinotropins, or compression and destruction of normal pituitary tissue. Patients may present primarily with neurological (or visual) complaints, but may also have endocrine abnormalities. Therefore, a thorough hormonal evaluation is necessary to determine if there is a clinically significant pituitary dysfunction and to direct management.

Objective: The aim of this study was to estimate the prevalence and type of endocrine dysfunction and hormonal abnormalities in patients with pituitary macroadenoma and their association with certain demographic and radiological parameters.

Methods: Cross sectional study was carried out in a hospital setting at Dow University, Karachi Pakistan from October to December 2025. The total number of patients was 79 (10-60 years), who had an MRI confirming pituitary macroadenoma (≥10 mm). Clinical and radiological features were evaluated such as tumor symptoms, size of the tumour with the maximum diameter, and tumor extension suprasellar. Hormonal evaluation consisted of serum prolactin, TSH, free T4, morning cortisol, ACTH, IGF-1, LH, FSH and sex steroids which were determined by clinical indication. Data were analyzed using SPSS where categorical variables were presented in frequency and percentage.

Results: The group ages most common were 30-39 years (25.3%) and there was a slight male predominance (54.4%). Headache (73.4%) and visual disturbance (62.0%) were the most common clinical features. The most common tumor size was 20–29 mm (46.8%). Overall, 58 (73.4%) patients had at least one endocrine abnormality. The most common abnormalities reported were hypogonadism (53.2%), hyperprolactinemia (43.0%), central hypothyroidism (39.2%), central adrenal insufficiency (27.8%) and low IGF-1/suspected GH deficiency (21.5%). Patients with tumors ≥30 mm (88.9%) had a higher incidence of endocrine dysfunction than did patients with tumors 10–29 mm (68.9%).

Conclusion: Pituitary macroadenoma is linked to a significant endocrine dysfunction burden, generally affecting one or more hormonal axes. Age and sex appropriate endocrine evaluation should be performed as part of the routine evaluation of patients with pituitary macroadenoma, especially those with larger tumors or suprasellar extension