{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:33:41Z","timestamp":1792582421899,"version":"4.5.0"},"reference-count":68,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Tumor consistency recently emerged as a key factor in surgical planning for pituitary adenomas, but its impact on postoperative endocrine function is still unclear. Our study aimed to evaluate the impact of tumor consistency on the development of postoperative pituitary deficiencies.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Single-center, retrospective analysis of consecutive pituitary surgeries performed between January 2017 and January 2021 at Policlinico Umberto I in Rome. All patients underwent radiological and biochemical evaluations at baseline, and hormone assessments 3 and 6\u00a0months after pituitary surgery. Postoperative MRI studies were used to determine resection rates following surgery. Data on tumor consistency, macroscopic appearance, neurosurgical approach, and intraoperative complications were collected.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Fifty patients [24 women, mean age 57\u2009\u00b1\u200913\u00a0years, median tumor volume 4800 mm<jats:sup>3<\/jats:sup> [95% CI 620\u20138828], were included. Greater tumor volume (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u200914.621, <jats:italic>p<\/jats:italic>\u2009=\u20090.006) and male sex (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u200912.178, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were associated with worse preoperative endocrine function. All patients underwent transsphenoidal adenomectomy. Fibrous consistency was observed in 10% of patients and was associated with a Ki-67 greater than 3% (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u20098.154, <jats:italic>p<\/jats:italic>\u2009=\u20090.04), greater risk of developing postoperative hormone deficiencies (\u03c7<jats:sup>2<\/jats:sup>\u2009=\u20094.485, <jats:italic>p<\/jats:italic>\u2009=\u20090.05, OR\u2009=\u20098.571; 95% CI: 0.876\u201383.908), and lower resection rates (\u03c72\u2009=\u20098.148, <jats:italic>p<\/jats:italic>\u2009=\u20090.004; OR 1.385, 95% CI; 1.040\u20131.844). Similarly, worse resection rates were observed in tumors with suprasellar extension (\u03c72\u2009=\u20095.048, <jats:italic>p<\/jats:italic>\u2009=\u20090.02; OR\u2009=\u20096.000, 95% CI; 1.129\u201331.880) and CSI (\u03c72\u2009=\u20094.000, <jats:italic>p<\/jats:italic>\u2009=\u20090.04; OR\u2009=\u20093.857, 95% CI; 0.997\u201314.916).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Tumor consistency might provide useful information about postoperative pituitary function, likely due to its impact on surgical procedures. Further prospective studies with larger cohorts are needed to confirm our preliminary findings.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-023-01334-1","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T04:02:14Z","timestamp":1682481734000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Pituitary adenoma consistency affects postoperative hormone function: a retrospective study"],"prefix":"10.1186","volume":"23","author":[{"given":"Dario","family":"De Alcubierre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Puliani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Cozzolino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Hasenmajer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Minnetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Sada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Martines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Zaccagnino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Gennaro","family":"Ruggeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Pofi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Sbardella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Anna","family":"Venneri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"issue":"3","key":"1334_CR1","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1002\/cncr.20412","volume":"101","author":"S Ezzat","year":"2004","unstructured":"Ezzat S, Asa SL, Couldwell WT, Barr CE, Dodge WE, Vance ML, et al. The prevalence of pituitary adenomas: a systematic review. Cancer. 2004;101(3):613\u20139.","journal-title":"Cancer"},{"issue":"10","key":"1334_CR2","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1056\/NEJMra1810772","volume":"382","author":"S Melmed","year":"2020","unstructured":"Melmed S. Pituitary-tumor endocrinopathies. N Engl J Med. 2020;382(10):937\u201350.","journal-title":"N Engl J Med"},{"issue":"6","key":"1334_CR3","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1530\/EJE-20-0497","volume":"183","author":"A Cozzolino","year":"2020","unstructured":"Cozzolino A, Feola T, Simonelli I, Puliani G, Hasenmajer V, Minnetti M, et al. Metabolic complications in acromegaly after neurosurgery: a meta-analysis. Eur J Endocrinol. 2020;183(6):597\u2013606.","journal-title":"Eur J Endocrinol"},{"issue":"5","key":"1334_CR4","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1001\/jama.2016.19699","volume":"317","author":"ME Molitch","year":"2017","unstructured":"Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017;317(5):516\u201324.","journal-title":"JAMA"},{"issue":"3","key":"1334_CR5","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1007\/s11102-011-0368-2","volume":"15","author":"M Berker","year":"2012","unstructured":"Berker M, Hazer DB, Yucel T, Gurlek A, Cila A, Aldur M, et al. Complications of endoscopic surgery of the pituitary adenomas: analysis of 570 patients and review of the literature. Pituitary. 2012;15(3):288\u2013300.","journal-title":"Pituitary"},{"issue":"2","key":"1334_CR6","doi-asserted-by":"publisher","first-page":"101299","DOI":"10.1016\/j.beem.2019.101299","volume":"33","author":"M Buchfelder","year":"2019","unstructured":"Buchfelder M, Schlaffer SM, Zhao Y. The optimal surgical techniques for pituitary tumors. Best Pract Res Clin Endocrinol Metab. 2019;33(2):101299.","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"1","key":"1334_CR7","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s00701-003-0174-3","volume":"146","author":"P Nomikos","year":"2004","unstructured":"Nomikos P, Ladar C, Fahlbusch R, Buchfelder M. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas \u2013 a study on 721 patients. Acta Neurochir (Wien). 2004;146(1):27\u201335.","journal-title":"Acta Neurochir (Wien)"},{"issue":"11","key":"1334_CR8","doi-asserted-by":"publisher","first-page":"5316","DOI":"10.1210\/jc.2019-00406","volume":"104","author":"R Pofi","year":"2019","unstructured":"Pofi R, Gunatilake S, Macgregor V, Shine B, Joseph R, Grossman AB, et al. Recovery of the hypothalamo-pituitary-adrenal axis after transsphenoidal adenomectomy for non-ACTH-secreting Macroadenomas. J Clin Endocrinol Metab. 2019;104(11):5316\u201324.","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"1334_CR9","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1111\/cen.13232","volume":"86","author":"E Sbardella","year":"2017","unstructured":"Sbardella E, Isidori AM, Woods CP, Argese N, Tomlinson JW, Shine B, et al. Baseline morning cortisol level as a predictor of pituitary-adrenal reserve: a comparison across three assays. Clin Endocrinol (Oxf). 2017;86(2):177\u201384.","journal-title":"Clin Endocrinol (Oxf)"},{"key":"1334_CR10","doi-asserted-by":"crossref","unstructured":"Little AS, Gardner PA, Fernandez-Miranda JC, Chicoine MR, Barkhoudarian G, Prevedello DM, et al. Pituitary gland recovery following fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenoma: results of a prospective multicenter study. J Neurosurg. 2019;133(6):1\u20137.","DOI":"10.3171\/2019.8.JNS191012"},{"issue":"4","key":"1334_CR11","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s11102-012-0439-z","volume":"16","author":"R Pratheesh","year":"2013","unstructured":"Pratheesh R, Rajaratnam S, Prabhu K, Mani SE, Chacko G, Chacko AG. The current role of transcranial surgery in the management of pituitary adenomas. Pituitary. 2013;16(4):419\u201334.","journal-title":"Pituitary"},{"key":"1334_CR12","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3389\/fendo.2019.00403","volume":"10","author":"Y Fan","year":"2019","unstructured":"Fan Y, Hua M, Mou A, Wu M, Liu X, Bao X, et al. Preoperative noninvasive radiomics approach predicts tumor consistency in patients with acromegaly: development and multicenter prospective validation. Front Endocrinol (Lausanne). 2019;10:403.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"1334_CR13","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1148\/radiol.2383042204","volume":"239","author":"A Pierallini","year":"2006","unstructured":"Pierallini A, Caramia F, Falcone C, Tinelli E, Paonessa A, Ciddio AB, et al. Pituitary macroadenomas: preoperative evaluation of consistency with diffusion-weighted MR imaging\u2013initial experience. Radiology. 2006;239(1):223\u201331.","journal-title":"Radiology"},{"key":"1334_CR14","doi-asserted-by":"publisher","first-page":"e449","DOI":"10.1016\/j.wneu.2018.09.137","volume":"121","author":"M Cappelletti","year":"2019","unstructured":"Cappelletti M, Ruggeri AG, Spizzichino L, D\u2019Amico A, D\u2019Avella E, Delfini R. Fibrous pituitary macroadenomas: predictive role of preoperative radiologic investigations for proper surgical planning in a cohort of 66 patients. World Neurosurg. 2019;121:e449\u201357.","journal-title":"World Neurosurg"},{"issue":"6","key":"1334_CR15","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1055\/s-0039-1694049","volume":"81","author":"JJ Yun","year":"2020","unstructured":"Yun JJ, Johans SJ, Shepherd DJ, Martin B, Joyce C, Borys E, et al. The utility of using preoperative MRI as a predictor for intraoperative pituitary adenoma consistency and surgical resection technique. J Neurol Surg B Skull Base. 2020;81(6):651\u20138.","journal-title":"J Neurol Surg B Skull Base"},{"issue":"5","key":"1334_CR16","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1080\/02688690601000717","volume":"20","author":"B Bahuleyan","year":"2006","unstructured":"Bahuleyan B, Raghuram L, Rajshekhar V, Chacko AG. To assess the ability of MRI to predict consistency of pituitary macroadenomas. Br J Neurosurg. 2006;20(5):324\u20136.","journal-title":"Br J Neurosurg"},{"key":"1334_CR17","volume-title":"WHO classification of tumours of endocrine organs","author":"RV Lloyd","year":"2017","unstructured":"Lloyd RV, Osamura RY, Kl\u00f6ppel G, Rosai J. WHO classification of tumours of endocrine organs. IARC; 2017."},{"issue":"6","key":"1334_CR18","first-page":"762","volume":"19","author":"GU Mehta","year":"2017","unstructured":"Mehta GU, Lonser RR. Management of hormone-secreting pituitary adenomas. Neuro Oncol. 2017;19(6):762\u201373.","journal-title":"Neuro Oncol"},{"key":"1334_CR19","doi-asserted-by":"publisher","first-page":"40792","DOI":"10.1038\/srep40792","volume":"7","author":"CC Chuang","year":"2017","unstructured":"Chuang CC, Lin SY, Pai PC, Yan JL, Toh CH, Lee ST, et al. Different volumetric measurement methods for pituitary adenomas and their crucial clinical significance. Sci Rep. 2017;7:40792.","journal-title":"Sci Rep"},{"issue":"6","key":"1334_CR20","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1046\/j.1365-2265.2001.01406.x","volume":"55","author":"M Regal","year":"2001","unstructured":"Regal M, Paramo C, Sierra SM, Garcia-Mayor RV. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clin Endocrinol (Oxf). 2001;55(6):735\u201340.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"1","key":"1334_CR21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s12020-016-1159-3","volume":"56","author":"S Jasim","year":"2017","unstructured":"Jasim S, Alahdab F, Ahmed AT, Tamhane S, Prokop LJ, Nippoldt TB, et al. Mortality in adults with hypopituitarism: a systematic review and meta-analysis. Endocrine. 2017;56(1):33\u201342.","journal-title":"Endocrine"},{"issue":"4","key":"1334_CR22","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1097\/MED.0000000000000169","volume":"22","author":"I Crespo","year":"2015","unstructured":"Crespo I, Santos A, Webb SM. Quality of life in patients with hypopituitarism. Curr Opin Endocrinol Diabetes Obes. 2015;22(4):306\u201312.","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"issue":"1","key":"1334_CR23","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.otc.2015.09.004","volume":"49","author":"D Bresson","year":"2016","unstructured":"Bresson D, Herman P, Polivka M, Froelich S. Sellar lesions\/pathology. Otolaryngol Clin North Am. 2016;49(1):63\u201393.","journal-title":"Otolaryngol Clin North Am"},{"key":"1334_CR24","doi-asserted-by":"crossref","unstructured":"Harary M, DiRisio AC, Dawood HY, Kim J, Lamba N, Cho CH, et al. Endocrine function and gland volume after endoscopic transsphenoidal surgery for nonfunctional pituitary macroadenomas. J Neurosurg. 2018;131(4):1\u201310.","DOI":"10.3171\/2018.5.JNS181054"},{"issue":"4","key":"1334_CR25","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00701-015-2699-7","volume":"158","author":"BM Davies","year":"2016","unstructured":"Davies BM, Carr E, Soh C, Gnanalingham KK. Assessing size of pituitary adenomas: a comparison of qualitative and quantitative methods on MR. Acta Neurochir (Wien). 2016;158(4):677\u201383.","journal-title":"Acta Neurochir (Wien)"},{"issue":"2","key":"1334_CR26","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","volume":"45","author":"EA Eisenhauer","year":"2009","unstructured":"Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228\u201347.","journal-title":"Eur J Cancer"},{"issue":"5","key":"1334_CR27","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1530\/EJE-08-0205","volume":"159","author":"C Jimenez","year":"2008","unstructured":"Jimenez C, Burman P, Abs R, Clemmons DR, Drake WM, Hutson KR, et al. Follow-up of pituitary tumor volume in patients with acromegaly treated with pegvisomant in clinical trials. Eur J Endocrinol. 2008;159(5):517\u201323.","journal-title":"Eur J Endocrinol"},{"issue":"12","key":"1334_CR28","doi-asserted-by":"publisher","first-page":"e51788","DOI":"10.1371\/journal.pone.0051788","volume":"7","author":"J Egger","year":"2012","unstructured":"Egger J, Kapur T, Nimsky C, Kikinis R. Pituitary adenoma volumetry with 3D slicer. PLoS One. 2012;7(12):e51788.","journal-title":"PLoS One"},{"issue":"2","key":"1334_CR29","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1097\/00006123-199702000-00001","volume":"40","author":"I Ciric","year":"1997","unstructured":"Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery. 1997;40(2):225\u201336. discussion 36-7.","journal-title":"Neurosurgery"},{"issue":"Suppl 1","key":"1334_CR30","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1227\/NEU.0000000000000405","volume":"61","author":"A Jahangiri","year":"2014","unstructured":"Jahangiri A, Wagner J, Han SW, Tran MT, Miller LM, Tom MW, et al. Rate and time course of improvement in endocrine function after more than 1000 pituitary operations. Neurosurgery. 2014;61(Suppl 1):163\u20136.","journal-title":"Neurosurgery"},{"issue":"9\u201310","key":"1334_CR31","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1159\/000508107","volume":"110","author":"E Sbardella","year":"2020","unstructured":"Sbardella E, Minnetti M, Pofi R, Cozzolino A, Greco E, Gianfrilli D, et al. Late effects of parasellar lesion treatment: hypogonadism and infertility. Neuroendocrinology. 2020;110(9\u201310):868\u201381.","journal-title":"Neuroendocrinology"},{"issue":"10","key":"1334_CR32","doi-asserted-by":"publisher","first-page":"3696","DOI":"10.1210\/jcem.84.10.6019","volume":"84","author":"SM Webb","year":"1999","unstructured":"Webb SM, Rigla M, Wagner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999;84(10):3696\u2013700.","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"1334_CR33","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1007\/s40618-019-01146-y","volume":"43","author":"AM Isidori","year":"2020","unstructured":"Isidori AM, Arnaldi G, Boscaro M, Falorni A, Giordano C, Giordano R, et al. Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian society of endocrinology expert opinion. J Endocrinol Invest. 2020;43(5):683\u201396.","journal-title":"J Endocrinol Invest"},{"key":"1334_CR34","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.wneu.2017.01.022","volume":"101","author":"A Li","year":"2017","unstructured":"Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T. Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary adenoma: a systematic review and meta-analysis. World Neurosurg. 2017;101:236\u201346.","journal-title":"World Neurosurg"},{"issue":"4","key":"1334_CR35","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s00701-012-1285-5","volume":"154","author":"S Berkmann","year":"2012","unstructured":"Berkmann S, Fandino J, Muller B, Remonda L, Landolt H. Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma. Acta Neurochir (Wien). 2012;154(4):639\u201347.","journal-title":"Acta Neurochir (Wien)"},{"issue":"1","key":"1334_CR36","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12902-021-00777-8","volume":"21","author":"K Seejore","year":"2021","unstructured":"Seejore K, Alavi SA, Pearson SM, Robins JMW, Alromhain B, Sheikh A, et al. Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes. BMC Endocr Disord. 2021;21(1):116.","journal-title":"BMC Endocr Disord"},{"issue":"8","key":"1334_CR37","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1136\/jnnp-2012-303194","volume":"84","author":"M Ammirati","year":"2013","unstructured":"Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013;84(8):843\u20139.","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"8","key":"1334_CR38","doi-asserted-by":"publisher","first-page":"2097","DOI":"10.1007\/s00701-021-04762-x","volume":"163","author":"R Rotermund","year":"2021","unstructured":"Rotermund R, Regelsberger J, Osterhage K, Aberle J, Flitsch J. 4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery. Acta Neurochir (Wien). 2021;163(8):2097\u2013106.","journal-title":"Acta Neurochir (Wien)"},{"issue":"6","key":"1334_CR39","doi-asserted-by":"publisher","first-page":"3675","DOI":"10.1007\/s10143-022-01866-5","volume":"45","author":"P Sumislawski","year":"2022","unstructured":"Sumislawski P, Piffko A, Huckhagel T, Ryba A, Burkhardt T, Aberle J, et al. Exoscopic vs. microscopic transsphenoidal surgery for Cushing\u2019s disease: a retrospective single-center study on 388 patients. Neurosurg Rev. 2022;45(6):3675\u201381.","journal-title":"Neurosurg Rev"},{"issue":"2","key":"1334_CR40","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1111\/cen.13048","volume":"85","author":"V Munro","year":"2016","unstructured":"Munro V, Tugwell B, Doucette S, Clarke DB, Lacroix A, Imran SA. Recovery of adrenal function after chronic secondary adrenal insufficiency in patients with hypopituitarism. Clin Endocrinol (Oxf). 2016;85(2):216\u201322.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"9","key":"1334_CR41","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1007\/s40618-020-01495-z","volume":"44","author":"A Dutta","year":"2021","unstructured":"Dutta A, Gupta N, Walia R, Bhansali A, Dutta P, Bhadada SK, et al. Remission in Cushing\u2019s disease is predicted by cortisol burden and its withdrawal following pituitary surgery. J Endocrinol Invest. 2021;44(9):1869\u201378.","journal-title":"J Endocrinol Invest"},{"issue":"5","key":"1334_CR42","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s11102-018-0904-4","volume":"21","author":"J Honegger","year":"2018","unstructured":"Honegger J, Grimm F. The experience with transsphenoidal surgery and its importance to outcomes. Pituitary. 2018;21(5):545\u201355.","journal-title":"Pituitary"},{"key":"1334_CR43","doi-asserted-by":"publisher","first-page":"16194","DOI":"10.1038\/srep16194","volume":"5","author":"CC Lee","year":"2015","unstructured":"Lee CC, Chen CM, Lee ST, Wei KC, Pai PC, Toh CH, et al. Prediction of long-term post-operative testosterone replacement requirement based on the pre-operative tumor volume and testosterone level in Pituitary Macroadenoma. Sci Rep. 2015;5:16194.","journal-title":"Sci Rep"},{"issue":"2","key":"1334_CR44","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1007\/s11102-010-0273-0","volume":"14","author":"A Krzentowska-Korek","year":"2011","unstructured":"Krzentowska-Korek A, Golkowski F, Baldys-Waligorska A, Hubalewska-Dydejczyk A. Efficacy and complications of neurosurgical treatment of acromegaly. Pituitary. 2011;14(2):157\u201362.","journal-title":"Pituitary"},{"issue":"3","key":"1334_CR45","doi-asserted-by":"publisher","first-page":"643","DOI":"10.3171\/2012.9.JNS12519","volume":"118","author":"MC Murphy","year":"2013","unstructured":"Murphy MC, Huston J 3rd, Glaser KJ, Manduca A, Meyer FB, Lanzino G, et al. Preoperative assessment of meningioma stiffness using magnetic resonance elastography. J Neurosurg. 2013;118(3):643\u20138.","journal-title":"J Neurosurg"},{"issue":"4","key":"1334_CR46","first-page":"485","volume":"14","author":"M Loyo","year":"1984","unstructured":"Loyo M, Kleriga E, Mateos H, de Leo R, Delgado A. Combined supra-infrasellar approach for large pituitary tumors. Neurosurgery. 1984;14(4):485\u20138.","journal-title":"Neurosurgery"},{"issue":"5","key":"1334_CR47","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1055\/s-0035-1549005","volume":"76","author":"KA Smith","year":"2015","unstructured":"Smith KA, Leever JD, Chamoun RB. Prediction of consistency of pituitary adenomas by magnetic resonance imaging. J Neurol Surg B Skull Base. 2015;76(5):340\u20133.","journal-title":"J Neurol Surg B Skull Base"},{"issue":"6","key":"1334_CR48","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.3171\/2019.3.JNS19367","volume":"132","author":"A Micko","year":"2019","unstructured":"Micko A, Oberndorfer J, Weninger WJ, Vila G, Hoftberger R, Wolfsberger S, et al. Challenging Knosp high-grade pituitary adenomas. J Neurosurg. 2019;132(6):1739\u201346.","journal-title":"J Neurosurg"},{"issue":"2","key":"1334_CR49","doi-asserted-by":"publisher","first-page":"345","DOI":"10.3171\/2010.9.JNS10262","volume":"114","author":"S Di Maio","year":"2011","unstructured":"Di Maio S, Cavallo LM, Esposito F, Stagno V, Corriero OV, Cappabianca P. Extended endoscopic endonasal approach for selected pituitary adenomas: early experience. J Neurosurg. 2011;114(2):345\u201353.","journal-title":"J Neurosurg"},{"issue":"1","key":"1334_CR50","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s00234-015-1591-8","volume":"58","author":"Z Ma","year":"2016","unstructured":"Ma Z, He W, Zhao Y, Yuan J, Zhang Q, Wu Y, et al. Predictive value of PWI for blood supply and T1-spin echo MRI for consistency of pituitary adenoma. Neuroradiology. 2016;58(1):51\u20137.","journal-title":"Neuroradiology"},{"issue":"8","key":"1334_CR51","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1007\/s007010050179","volume":"140","author":"T Iuchi","year":"1998","unstructured":"Iuchi T, Saeki N, Tanaka M, Sunami K, Yamaura A. MRI prediction of fibrous pituitary adenomas. Acta Neurochir (Wien). 1998;140(8):779\u201386.","journal-title":"Acta Neurochir (Wien)"},{"issue":"2","key":"1334_CR52","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1007\/s11102-011-0319-y","volume":"15","author":"GK Leung","year":"2012","unstructured":"Leung GK, Yuen MM, Chow WS, Tse PY, Lui WM. An endoscopic modification of the simultaneous \u2018above and below\u2019 approach to large pituitary adenomas. Pituitary. 2012;15(2):237\u201341.","journal-title":"Pituitary"},{"key":"1334_CR53","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000091568","volume":"34","author":"NF Maartens","year":"2006","unstructured":"Maartens NF, Kaye AH. Role of transcranial approaches in the treatment of sellar and suprasellar lesions. Front Horm Res. 2006;34:1\u201328.","journal-title":"Front Horm Res"},{"issue":"12","key":"1334_CR54","doi-asserted-by":"publisher","first-page":"2217","DOI":"10.1007\/s00701-014-2213-7","volume":"156","author":"P Cappabianca","year":"2014","unstructured":"Cappabianca P, Cavallo LM, Solari D, de Divitiis O, Chiaramonte C, Esposito F. Size does not matter. The intrigue of giant adenomas: a true surgical challenge. Acta Neurochir (Wien). 2014;156(12):2217\u201320.","journal-title":"Acta Neurochir (Wien)"},{"issue":"3","key":"1334_CR55","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1007\/s12020-022-03161-1","volume":"78","author":"A AcitoresCancela","year":"2022","unstructured":"AcitoresCancela A, Rodriguez Berrocal V, Pian Arias H, Diez JJ, Iglesias P. Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery. Endocrine. 2022;78(3):559\u201369.","journal-title":"Endocrine"},{"key":"1334_CR56","doi-asserted-by":"crossref","unstructured":"Cohen-Cohen S, Helal A, Yin Z, Ball MK, Ehman RL, Van Gompel JJ, et al. Predicting pituitary adenoma consistency with preoperative magnetic resonance elastography. J Neurosurg. 2021;136(5):1\u20138.","DOI":"10.3171\/2021.6.JNS204425"},{"key":"1334_CR57","doi-asserted-by":"crossref","unstructured":"Schur S, Lasry, O., Tewfikc, M. A., Di Maio, S. Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery. Interdisciplinary Neurosurgery. 2019;20:100628.","DOI":"10.1016\/j.inat.2019.100628"},{"issue":"2","key":"1334_CR58","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s11102-016-0760-z","volume":"20","author":"A Romano","year":"2017","unstructured":"Romano A, Coppola V, Lombardi M, Lavorato L, Di Stefano D, Caroli E, et al. Predictive role of dynamic contrast enhanced T1-weighted MR sequences in pre-surgical evaluation of macroadenomas consistency. Pituitary. 2017;20(2):201\u20139.","journal-title":"Pituitary"},{"issue":"3","key":"1334_CR59","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.ando.2015.04.003","volume":"76","author":"C Cortet-Rudelli","year":"2015","unstructured":"Cortet-Rudelli C, Bonneville JF, Borson-Chazot F, Clavier L, CocheDequeant B, Desailloud R, et al. Post-surgical management of non-functioning pituitary adenoma. Ann Endocrinol (Paris). 2015;76(3):228\u201338.","journal-title":"Ann Endocrinol (Paris)"},{"key":"1334_CR60","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.jocn.2018.10.065","volume":"58","author":"L Lv","year":"2018","unstructured":"Lv L, Zhang B, Wang M, Yin S, Zhou P, Hu Y, et al. Invasive pituitary adenomas with gross total resection: the wait-and-see policy during postoperative management. J Clin Neurosci. 2018;58:49\u201355.","journal-title":"J Clin Neurosci"},{"issue":"12","key":"1334_CR61","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1007\/s00701-014-2210-x","volume":"156","author":"S Berkmann","year":"2014","unstructured":"Berkmann S, Schlaffer S, Nimsky C, Fahlbusch R, Buchfelder M. Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging. Acta Neurochir (Wien). 2014;156(12):2233\u201343. discussion 43.","journal-title":"Acta Neurochir (Wien)"},{"issue":"3","key":"1334_CR62","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1007\/s11102-011-0350-z","volume":"15","author":"CP Hofstetter","year":"2012","unstructured":"Hofstetter CP, Nanaszko MJ, Mubita LL, Tsiouris J, Anand VK, Schwartz TH. Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery. Pituitary. 2012;15(3):450\u201363.","journal-title":"Pituitary"},{"issue":"6","key":"1334_CR63","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.neuchi.2017.06.003","volume":"63","author":"AK Thotakura","year":"2017","unstructured":"Thotakura AK, Patibandla MR, Panigrahi MK, Mahadevan A. Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie. 2017;63(6):453\u20137.","journal-title":"Neurochirurgie"},{"key":"1334_CR64","doi-asserted-by":"publisher","first-page":"108931","DOI":"10.1016\/j.ejrad.2020.108931","volume":"126","author":"A Yao","year":"2020","unstructured":"Yao A, Rutland JW, Verma G, Banihashemi A, Padormo F, Tsankova NM, et al. Pituitary adenoma consistency: direct correlation of ultrahigh field 7T MRI with histopathological analysis. Eur J Radiol. 2020;126:108931.","journal-title":"Eur J Radiol"},{"key":"1334_CR65","doi-asserted-by":"crossref","unstructured":"Rutland JW, Loewenstern J, Ranti D, Tsankova NM, Bellaire CP, Bederson JB, et al. Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J Neurosurg. 2020;134(3):1\u20139.","DOI":"10.3171\/2019.12.JNS192940"},{"issue":"3","key":"1334_CR66","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s11102-016-0706-5","volume":"19","author":"JD Hughes","year":"2016","unstructured":"Hughes JD, Fattahi N, Van Gompel J, Arani A, Ehman R, Huston J 3rd. Magnetic resonance elastography detects tumoral consistency in pituitary macroadenomas. Pituitary. 2016;19(3):286\u201392.","journal-title":"Pituitary"},{"issue":"Suppl 3","key":"1334_CR67","doi-asserted-by":"publisher","first-page":"S216","DOI":"10.4103\/2230-8210.84871","volume":"15","author":"V Chaudhary","year":"2011","unstructured":"Chaudhary V, Bano S. Imaging of the pituitary: recent advances. Indian J Endocrinol Metab. 2011;15(Suppl 3):S216\u201323.","journal-title":"Indian J Endocrinol Metab"},{"issue":"11","key":"1334_CR68","doi-asserted-by":"publisher","first-page":"3888","DOI":"10.1210\/jc.2016-2118","volume":"101","author":"M Fleseriu","year":"2016","unstructured":"Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(11):3888\u2013921.","journal-title":"J Clin Endocrinol Metab"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-023-01334-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-023-01334-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-023-01334-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T05:02:07Z","timestamp":1682485327000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-023-01334-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["1334"],"URL":"https:\/\/doi.org\/10.1186\/s12902-023-01334-1","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,26]]},"assertion":[{"value":"27 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the \u2018Sapienza\u2019 University of Rome Ethics Committee (reference number 6288). Written informed consent to participate in the study was obtained from each patient after full explanation of the purpose and nature of all procedures used.The study was performed in accordance with the principles of the Declaration of Helsinki (1964) and its subsequent amendments.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"92"}}