{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:29:58Z","timestamp":1772724598128,"version":"3.50.1"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Nonfunctioning pituitary adenomas (NFPAs) often present with associated mild hyperprolactinemia, described in literature as \"stalk effect.\" The presence of preoperative hyperprolactinemia caused by tumor compression of the pituitary stalk and endocrinological outcomes has been noted; however, a detailed investigation on the impact on perioperative endocrinological outcome is lacking. The authors aimed to determine whether elevated preoperative serum prolactin concentrations are associated with increased risk of perioperative pituitary dysfunction in patients with NFPAs undergoing endonasal transsphenoidal surgery (ETS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a single-center retrospective cohort study of patients who underwent ETS for NFPAs between January 2013 and April 2023. Patients were divided into two groups based on preoperative prolactin concentrations: normal or hyperprolactinemic (prolactin values above upper limit of reference range, adjusted for sex). Outcomes included perioperative endocrinological function and surgical outcomes. Multivariable analysis was conducted to identify factors associated with perioperative endocrinological function outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 244 patients (140 [57%] males; median age 59 years) with a median follow-up of 65 months, 131 (54%) had hyperprolactinemia. Compared with patients with normal preoperative prolactin levels (n = 113), the hyperprolactinemia group had similar tumor size (median diameter 2.5 cm vs 2.3 cm, p = 0.102) but higher rates of cavernous sinus invasion (99% vs 91%, p = 0.035), pituitary stalk deviation (95% vs 74%, p = 0.001), stalk bending (14% vs 1%, p = 0.001), preoperative secondary hypothyroidism (39% vs 22%, p = 0.005), and adrenal insufficiency (AI; 34% vs 22%, p = 0.048). Postoperatively, the hyperprolactinemia group showed higher rates of new secondary hypothyroidism (16% vs 7%, p = 0.048) and new permanent AI (16% vs 6%, p = 0.046). Multivariable analysis revealed preoperative high prolactin as an independent predictor of preoperative secondary hypothyroidism (OR 1.83, 95% CI 1.17\u20133.44; p = 0.046) and its postoperative deterioration (OR 2.65, 95% CI 1.02\u20137.69; p = 0.042). Maximum tumor diameter was also a significant predictor of various endocrinological dysfunctions both pre- and postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Preoperative hyperprolactinemia in patients with NFPA is associated with higher risks of specific perioperative endocrinological dysfunction and pronounced pituitary stalk deviation. These findings highlight the utility of preoperative prolactin levels as a biomarker for predicting postoperative endocrinological outcomes, potentially enhancing risk assessment and guiding personalized perioperative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.jns243206","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T01:39:52Z","timestamp":1760751592000},"page":"190-199","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative serum prolactin as a predictor of endocrine outcomes in nonfunctioning pituitary adenoma surgery: revisiting the \"stalk effect\""],"prefix":"10.3171","volume":"144","author":[{"given":"Yuki","family":"Shinya","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine S.","family":"Herndon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandhya R.","family":"Palit","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukwoo","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Saez-Alegre","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramin A.","family":"Morshed","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irina","family":"Bancos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Donegan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Mayo Clinic, Rochester; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Pinheiro Neto","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredric B.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John L. D.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"JAMA","first-page":"516","article-title":"Diagnosis and treatment of pituitary adenomas: a review","volume":"317","author":"Molitch ME","year":"2017","unstructured":"Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017;317(5):516\u2013524."},{"issue":"2","key":"b2","series-title":"Pituitary","first-page":"111","article-title":"Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas","volume":"21","author":"Ntali G","year":"2018","unstructured":"Ntali G, Wass JA. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary. 2018;21(2):111\u2013118."},{"issue":"4","key":"b3","series-title":"Neurosurgery","first-page":"E527","article-title":"Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas","volume":"79","author":"Fleseriu M","year":"2016","unstructured":"Fleseriu M, Bodach ME, Tumialan LM,  Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery. 2016;79(4):E527\u2013E529."},{"issue":"3","key":"b4","series-title":"Endocr J","first-page":"421","article-title":"Anterior pituitary function in patients with nonfunctioning pituitary adenoma: results of longitudinal follow-up","volume":"42","author":"Tominaga A","year":"1995","unstructured":"Tominaga A, Uozumi T, Arita K, Kurisu K, Yano T, Hirohata T. Anterior pituitary function in patients with nonfunctioning pituitary adenoma: results of longitudinal follow-up. Endocr J. 1995;42(3):421\u2013427."},{"issue":"11","key":"b5","series-title":"J Clin Endocrinol Metab","first-page":"1277","article-title":"Clinical progress in the treatment of exophthalmos of Graves\u2019 disease, with particular reference to the effect of pituitary surgery","volume":"17","author":"Mc CE","year":"1957","unstructured":"Mc CE, Clamen M, Gardner WJ. Clinical progress in the treatment of exophthalmos of Graves\u2019 disease, with particular reference to the effect of pituitary surgery. J Clin Endocrinol Metab. 1957;17(11):1277\u20131292."},{"issue":"9","key":"b6","series-title":"Am Surg","first-page":"603","article-title":"Transection of the hypophyseal stalk in the management of metastatic mammary carcinoma","volume":"24","author":"Dugger GS","year":"1958","unstructured":"Dugger GS, Van Wyke J, Newsome JF. Transection of the hypophyseal stalk in the management of metastatic mammary carcinoma. Am Surg. 1958;24(9):603\u2013608."},{"issue":"13","key":"b7","series-title":"N Engl J Med","first-page":"707","article-title":"Elevated serum prolactin levels after pituitary-stalk section in man","volume":"285","author":"Turkington RW","year":"1971","unstructured":"Turkington RW, Underwood LE, Van Wyk JJ. Elevated serum prolactin levels after pituitary-stalk section in man. N Engl J Med. 1971;285(13):707\u2013710."},{"issue":"6","key":"b8","series-title":"J Neurosurg","first-page":"1043","article-title":"Excessively high prolactin level in a patient with a nonprolactin-secreting adenoma. Case report","volume":"89","author":"Albuquerque FC","year":"1998","unstructured":"Albuquerque FC, Hinton DR, Weiss MH. Excessively high prolactin level in a patient with a nonprolactin-secreting adenoma. Case report. 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Pituitary. 2008;11(2):141\u2013146."},{"issue":"1","key":"b11","series-title":"Neuroendocrinology","first-page":"7","article-title":"Pitfalls in the diagnostic evaluation of hyperprolactinemia","volume":"109","author":"Vilar L","year":"2019","unstructured":"Vilar L, Vilar CF, Lyra R, Freitas MDC. Pitfalls in the diagnostic evaluation of hyperprolactinemia. Neuroendocrinology. 2019;109(1):7\u201319."},{"issue":"2","key":"b12","series-title":"Endocrine","first-page":"837","article-title":"Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery","volume":"85","author":"Sakata K","year":"2024","unstructured":"Sakata K, Hashimoto A, Takeshige N,  Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery. Endocrine. 2024;85(2):837\u2013848."},{"issue":"5","key":"b13","series-title":"J Clin Endocrinol Metab","first-page":"1789","article-title":"The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas","volume":"85","author":"Arafah BM","year":"2000","unstructured":"Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. 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Mayo Clin Proc. 2021;96(8):2043\u20132057."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"165","article-title":"Safe and efficacious therapeutic outcomes with salvage endonasal transsphenoidal surgery for pituitary adenoma progression following stereotactic radiosurgery","volume":"143","author":"Shinya Y","year":"2025","unstructured":"Shinya Y, Hong S, Wipplinger C,  Safe and efficacious therapeutic outcomes with salvage endonasal transsphenoidal surgery for pituitary adenoma progression following stereotactic radiosurgery. J Neurosurg. 2025;143(1):165\u2013173."},{"issue":"3","key":"b16","series-title":"J Neurosurg","first-page":"448","article-title":"Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients","volume":"103","author":"Nemergut EC","year":"2005","unstructured":"Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005;103(3):448\u2013454."},{"issue":"5","key":"b17","series-title":"Neurosurgery","first-page":"949","article-title":"Diabetes insipidus after endoscopic transsphenoidal surgery","volume":"87","author":"Burke WT","year":"2020","unstructured":"Burke WT, Cote DJ, Penn DL, Iuliano S, McMillen K, Laws ER. Diabetes insipidus after endoscopic transsphenoidal surgery. Neurosurgery. 2020;87(5):949\u2013955."},{"issue":"3","key":"b18","series-title":"J Neurooncol","first-page":"477","article-title":"The pituitary stalk effect: is it a passing phenomenon?","volume":"117","author":"Bergsneider M","year":"2014","unstructured":"Bergsneider M, Mirsadraei L, Yong WH,  The pituitary stalk effect: is it a passing phenomenon? J Neurooncol. 2014;117(3):477\u2013484."},{"issue":"3","key":"b19","series-title":"J Neurosurg","first-page":"781","article-title":"Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas","volume":"141","author":"Shinya Y","year":"2024","unstructured":"Shinya Y, Atkinson JLD, Erickson D,  Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas. J Neurosurg. 2024;141(3):781\u2013789."},{"issue":"4","key":"b20","series-title":"J Neurosurg","first-page":"1043","article-title":"Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study","volume":"132","author":"Little AS","year":"2020","unstructured":"Little AS, Kelly DF, White WL,  Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study. 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Neurosurgery. 1993;33(4):610\u2013618."},{"issue":"6","key":"b23","series-title":"J Clin Endocrinol Metab","first-page":"1488","article-title":"Approach to the patient: a case with an unusual cause of hypopituitarism","volume":"108","author":"Das L","year":"2023","unstructured":"Das L, Dutta P. Approach to the patient: a case with an unusual cause of hypopituitarism. J Clin Endocrinol Metab. 2023;108(6):1488\u20131504."},{"issue":"5","key":"b1","series-title":"JAMA","first-page":"516","article-title":"Diagnosis and treatment of pituitary adenomas: a review","volume":"317","author":"Molitch ME","year":"2017","unstructured":"Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017;317(5):516\u2013524."},{"issue":"2","key":"b2","series-title":"Pituitary","first-page":"111","article-title":"Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas","volume":"21","author":"Ntali G","year":"2018","unstructured":"Ntali G, Wass JA. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary. 2018;21(2):111\u2013118."},{"issue":"4","key":"b3","series-title":"Neurosurgery","first-page":"E527","article-title":"Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas","volume":"79","author":"Fleseriu M","year":"2016","unstructured":"Fleseriu M, Bodach ME, Tumialan LM,  Congress of Neurological Surgeons systematic review and evidence-based guideline for pretreatment endocrine evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery. 2016;79(4):E527\u2013E529."},{"issue":"3","key":"b4","series-title":"Endocr J","first-page":"421","article-title":"Anterior pituitary function in patients with nonfunctioning pituitary adenoma: results of longitudinal follow-up","volume":"42","author":"Tominaga A","year":"1995","unstructured":"Tominaga A, Uozumi T, Arita K, Kurisu K, Yano T, Hirohata T. Anterior pituitary function in patients with nonfunctioning pituitary adenoma: results of longitudinal follow-up. Endocr J. 1995;42(3):421\u2013427."},{"issue":"11","key":"b5","series-title":"J Clin Endocrinol Metab","first-page":"1277","article-title":"Clinical progress in the treatment of exophthalmos of Graves\u2019 disease, with particular reference to the effect of pituitary surgery","volume":"17","author":"Mc CE","year":"1957","unstructured":"Mc CE, Clamen M, Gardner WJ. Clinical progress in the treatment of exophthalmos of Graves\u2019 disease, with particular reference to the effect of pituitary surgery. J Clin Endocrinol Metab. 1957;17(11):1277\u20131292."},{"issue":"9","key":"b6","series-title":"Am Surg","first-page":"603","article-title":"Transection of the hypophyseal stalk in the management of metastatic mammary carcinoma","volume":"24","author":"Dugger GS","year":"1958","unstructured":"Dugger GS, Van Wyke J, Newsome JF. Transection of the hypophyseal stalk in the management of metastatic mammary carcinoma. Am Surg. 1958;24(9):603\u2013608."},{"issue":"13","key":"b7","series-title":"N Engl J Med","first-page":"707","article-title":"Elevated serum prolactin levels after pituitary-stalk section in man","volume":"285","author":"Turkington RW","year":"1971","unstructured":"Turkington RW, Underwood LE, Van Wyk JJ. Elevated serum prolactin levels after pituitary-stalk section in man. N Engl J Med. 1971;285(13):707\u2013710."},{"issue":"6","key":"b8","series-title":"J Neurosurg","first-page":"1043","article-title":"Excessively high prolactin level in a patient with a nonprolactin-secreting adenoma. Case report","volume":"89","author":"Albuquerque FC","year":"1998","unstructured":"Albuquerque FC, Hinton DR, Weiss MH. Excessively high prolactin level in a patient with a nonprolactin-secreting adenoma. Case report. J Neurosurg. 1998;89(6):1043\u20131046."},{"issue":"5","key":"b9","series-title":"Neurosurgery","first-page":"834","article-title":"Magnetic resonance imaging measurements of pituitary stalk compression and deviation in patients with nonprolactin-secreting intrasellar and parasellar tumors: lack of correlation with serum prolactin levels","volume":"34","author":"Smith MV","year":"1994","unstructured":"Smith MV, Laws ER Jr. Magnetic resonance imaging measurements of pituitary stalk compression and deviation in patients with nonprolactin-secreting intrasellar and parasellar tumors: lack of correlation with serum prolactin levels. Neurosurgery. 1994;34(5):834\u2013839."},{"issue":"2","key":"b10","series-title":"Pituitary","first-page":"141","article-title":"Hyperprolactinemia","volume":"11","author":"Chahal J","year":"2008","unstructured":"Chahal J, Schlechte J. Hyperprolactinemia. Pituitary. 2008;11(2):141\u2013146."},{"issue":"1","key":"b11","series-title":"Neuroendocrinology","first-page":"7","article-title":"Pitfalls in the diagnostic evaluation of hyperprolactinemia","volume":"109","author":"Vilar L","year":"2019","unstructured":"Vilar L, Vilar CF, Lyra R, Freitas MDC. Pitfalls in the diagnostic evaluation of hyperprolactinemia. Neuroendocrinology. 2019;109(1):7\u201319."},{"issue":"2","key":"b12","series-title":"Endocrine","first-page":"837","article-title":"Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery","volume":"85","author":"Sakata K","year":"2024","unstructured":"Sakata K, Hashimoto A, Takeshige N,  Clinical and radiographic characteristics of patients with non-functioning pituitary adenomas categorized according to their serum prolactin concentration: novel predictors of postoperative transient diabetes insipidus following surgery. Endocrine. 2024;85(2):837\u2013848."},{"issue":"5","key":"b13","series-title":"J Clin Endocrinol Metab","first-page":"1789","article-title":"The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas","volume":"85","author":"Arafah BM","year":"2000","unstructured":"Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR. The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab. 2000;85(5):1789\u20131793."},{"issue":"8","key":"b14","series-title":"Mayo Clin Proc","first-page":"2043","article-title":"Pituitary tumor surgery: comparison of endoscopic and microscopic techniques at a single center","volume":"96","author":"Van Gompel JJ","year":"2021","unstructured":"Van Gompel JJ, Atkinson JLD, Choby G,  Pituitary tumor surgery: comparison of endoscopic and microscopic techniques at a single center. Mayo Clin Proc. 2021;96(8):2043\u20132057."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"165","article-title":"Safe and efficacious therapeutic outcomes with salvage endonasal transsphenoidal surgery for pituitary adenoma progression following stereotactic radiosurgery","volume":"143","author":"Shinya Y","year":"2025","unstructured":"Shinya Y, Hong S, Wipplinger C,  Safe and efficacious therapeutic outcomes with salvage endonasal transsphenoidal surgery for pituitary adenoma progression following stereotactic radiosurgery. J Neurosurg. 2025;143(1):165\u2013173."},{"issue":"3","key":"b16","series-title":"J Neurosurg","first-page":"448","article-title":"Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients","volume":"103","author":"Nemergut EC","year":"2005","unstructured":"Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005;103(3):448\u2013454."},{"issue":"5","key":"b17","series-title":"Neurosurgery","first-page":"949","article-title":"Diabetes insipidus after endoscopic transsphenoidal surgery","volume":"87","author":"Burke WT","year":"2020","unstructured":"Burke WT, Cote DJ, Penn DL, Iuliano S, McMillen K, Laws ER. Diabetes insipidus after endoscopic transsphenoidal surgery. Neurosurgery. 2020;87(5):949\u2013955."},{"issue":"3","key":"b18","series-title":"J Neurooncol","first-page":"477","article-title":"The pituitary stalk effect: is it a passing phenomenon?","volume":"117","author":"Bergsneider M","year":"2014","unstructured":"Bergsneider M, Mirsadraei L, Yong WH,  The pituitary stalk effect: is it a passing phenomenon? J Neurooncol. 2014;117(3):477\u2013484."},{"issue":"3","key":"b19","series-title":"J Neurosurg","first-page":"781","article-title":"Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas","volume":"141","author":"Shinya Y","year":"2024","unstructured":"Shinya Y, Atkinson JLD, Erickson D,  Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas. J Neurosurg. 2024;141(3):781\u2013789."},{"issue":"4","key":"b20","series-title":"J Neurosurg","first-page":"1043","article-title":"Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study","volume":"132","author":"Little AS","year":"2020","unstructured":"Little AS, Kelly DF, White WL,  Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study. J Neurosurg. 2020;132(4):1043\u20131053."},{"issue":"2","key":"b21","series-title":"Pituitary","first-page":"284","article-title":"Postoperative diabetes insipidus: how to define and grade this complication?","volume":"24","author":"de Vries F","year":"2021","unstructured":"de Vries F, Lobatto DJ, Verstegen MJT, van Furth WR, Pereira AM, Biermasz NR. Postoperative diabetes insipidus: how to define and grade this complication? Pituitary. 2021;24(2):284\u2013291."},{"issue":"4","key":"b22","series-title":"Neurosurgery","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp E","year":"1993","unstructured":"Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. 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