Hypogonadotropic Hypogonadism Before and After Transsphenoidal Surgery for Non‐Functioning Pituitary Adenoma

OBJECTIVE: The effect of transsphenoidal surgery (TSS) on the hypothalamic-pituitary-gonadal (HPG) axis in patients with non-functioning pituitary adenomas (NFPA) is underexplored, especially in women. Our aim was to investigate the HPG axis function before and after TSS, its association with quality of life (QoL), and to identify factors that predict its recovery after TSS. DESIGN: This was a prospective cohort study. PATIENTS: One hundred twenty-two consecutive patients, 73 men and 49 women, with NFPA planned for TSS. MEASUREMENTS: Endocrine function and QoL were assessed before and 12 months after TSS. Psychological well-being was evaluated using the Psychological General Well-Being index (PGWBi). RESULTS: Before surgery, 50 of 73 (68%) men had hypogonadotropic hypogonadism (HH), of whom four (8%) recovered. Eight of 13 (62%) women of reproductive age had preoperative HH, of whom 5 (63%) regained regular menstrual cycles. Preoperative central hypothyroidism (p = 0.046) and male sex (p = 0.027) were predictors of persistent HH. The median total PGWBi score increased in both men and women following surgery (p < 0.001). Comparing psychological well-being within subgroups in patients with preoperative HH, categorised by sex (men or women of reproductive age) and postoperative recovery status, only women of reproductive age who recovered their HPG axis experienced improved psychological well-being. CONCLUSIONS: HH is frequent in men and women with NFPA planned for TSS. Postoperative HPG axis recovery rate is higher in women and is associated with improved QoL.