ORIGINAL ARTICLE Gender differences in presentation and outcome of nonfunctioning pituitary macroadenomas Carmela Caputo*, Tom Sutherland†, Stephen Farish‡, Peter McNeill§, Kong W. Ng* and Warrick J. Inder*¶** *Department of Endocrinology, St Vincent’s Hospital, †Department of Radiology, St Vincent’s Hospital, ‡Melbourne Medical School, University of Melbourne, §Department of Neurosurgery, St Vincent’s Hospital, Melbourne, Vic., ¶Department of Endocrinology, Princess Alexandra Hospital, and **School of Medicine, University of Queensland, Brisbane, Qld, Australia Summary Objectives Few data exist regarding gender differences in hor- monal outcomes in nonfunctioning pituitary macroadenomas (NFPMA). The aim was to assess whether there are gender dif- ferences in hormonal outcomes in NFPMA following pituitary surgery at a single centre. Design and methods Retrospective review of cases undergoing a first surgical procedure for NFPMA. Preoperative hormonal function was available for 122 cases at presentation and 94 cases 6 months postoperatively. Multiple hormone deficiency was defined as  2 hormonal axis losses. Tumour size and invasion on MRI scan were assessed independently by a single neuroradiologist. Results At presentation, men were more likely than women to have multiple hormonal deficiency (47% vs 28%, P = 0038). Premenopausal women tended to have smaller adenomas than men, but neither adenoma size nor invasion was associated with multiple hormonal deficiency at presentation. Postoperatively, differences were observed with only 14% of premenopausal women exhibiting multiple hormone deficiency, compared with 36% of postmenopausal women and 46% of men (P = 003). Overall, postoperative hormonal recovery was observed in over one-third of cases. Greatest recovery occurred in the gonadal axis of 60% (6/10) premenopausal women compared with 19% (8/43) of other groups combined (P = 0007). Conclusions Premenopausal women with NFPMA appear to have favourable hormonal outcomes. This may be due to a com- plex interplay between smaller tumour size and shorter disease duration. There should be no hesitation in offering pituitary sur- gery to premenopausal women with NFPMA, who have the most to gain in terms of restoration of hormonal function. (Received 3 April 2012; returned for revision 8 July 2012; finally revised 6 August 2012; accepted 6 August 2012) Introduction Pituitary adenomas are the commonest intracranial neoplasm, with prevalence studies showing approximately one in 1000 individuals having a clinically relevant pituitary adenoma. 1,2 In contrast, 10% of the population may harbour small pituitary adenomas detect- able on routine neuroimaging. 3 Recently, it has been shown that incidence rates increase with age are higher in women early in life but more common in men later in life. 4 Furthermore, men tend to have larger tumours, possibly due to delayed diagnosis. 4,5 Pituitary adenomas may be associated with hormone defi- ciency of varying degrees, with functioning tumours and mic- roadenomas having fewer deficiencies than nonfunctioning pituitary macroadenomas (NFPMA). 6–10 NFPMA have the high- est rate of hormonal disturbances, but few data exist examining gender differences. It has been observed that gonadal deficiency is common in both men and women. 6,7,11–13 Deficiencies of other pituitary hormones (thyroid and adrenal axes) are usually reported with genders combined and include cases of pituitary apoplexy. It is thus unclear whether there are specific gender dif- ferences in hormonal status at presentation and postoperatively in patients with NFPMA. The aim of this study was to determine whether such gender differences exist in hormonal function, both at presentation and postoperatively among subjects with NFPMA via a retrospective chart review. In addition, relationships between age at presenta- tion, adenoma size and invasiveness, and hormonal status both pre- and postoperatively have been examined. Patients and methods Between August 1995 and October 2010, 141 consecutive cases of NFPMA were identified who underwent their first pituitary sur- gery at St Vincent’s Hospital, Melbourne, Australia. One case had a craniotomy, but the remainder were operated via the trans- sphenoidal route. Surgery was undertaken by principal surgeon PM in 77% cases, and the remainder by four other surgeons. Sixteen cases presented with pituitary apoplexy and were excluded from hormonal analysis. Preoperative hormonal data were available at presentation for 122 cases, at 6 months for 94 cases, and for paired pre- and postoperative hormones for 93 Correspondence: Carmela Caputo, Department Endocrinology, 4th Floor Daly Wing, St Vincent’s Hospital, 35 Victoria Parade, Fitzroy, Vic. 3065, Australia. Tel.: +61 3 9288 3579; Fax: +613 9288 3590; E-mail: carmela.caputo@svhm.org.au 564 © 2012 Blackwell Publishing Ltd Clinical Endocrinology (2013) 78, 564–570 doi: 10.1111/cen.12009