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

鞍上生殖细胞肿瘤治疗后下丘脑-垂体-性腺功能障碍的恢复。

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-1310
  • 作者列表:"Zhang K","Wang L","Duan L","Yang H","Pan H","Lian X","Yao Y","Zhu H
  • 发表时间:2021-04-01
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.

摘要

目的: 调查治疗后下丘脑-垂体-性腺 (HPG) 轴启动/恢复的发生率,并确定非启动/恢复的预测危险因素。 方法: 回顾性分析北京协和医院 (127-2006) 收治的2019例鞍上生殖细胞肿瘤 (GCT) 患者的临床资料。青春期前患者 (女孩随访至13岁,男孩随访至14岁) 和HPG功能障碍患者 (随访2年) 分为开始/恢复组和非开始/恢复组。 结果: 在127例鞍上GCT患者中,75例符合随访标准,其中28例 (37.3%) 经历了HPG轴启动/恢复。与非开始/恢复组相比,开始/恢复组包括更多的男性,并且具有更短的延迟诊断时间、更小的肿瘤大小、更低的全垂体功能减退率、更薄的垂体柄宽度、更低的视觉缺失率以及更高的血清睾酮和雌二醇水平。用于预测未启动/恢复的垂体柄宽度、肿瘤大小和延迟诊断时间的截止值分别为6.9毫米、6.9毫米和1.7年。肿瘤大小 ≥ 6.9毫米 (比值比 (OR) = 7.5,95% CI: 2.2-25.8,P = 0.001),全垂体功能减退 (OR = 5.0,95% CI: 1.4-17.6,P = 0.013),延迟诊断时间 ≥ 1.7年 (OR = 5.7,95% CI: 1.5-20.7,P = 0.009)是非起始/恢复的风险因素。 结论: 在鞍上GCT患者中,近3分之1的青春期前患者和HPG功能障碍患者在治疗后经历HPG轴启动/恢复。肿瘤大小 ≥ 6.9毫米mm、全垂体功能减退和延迟诊断时间 ≥ 1.7年被确定为未启动/恢复的预测风险因素.

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