High heterogeneity observed for baseline variables included in pituitary adenoma studies
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Key takeaways:
- Of 178 studies analyzing transsphenoidal intervention for a pituitary adenoma, 56% reported on baseline endocrine variables.
- Only 12% of studies reported baseline BMI and 9% of studies included ethnicity.
Common data elements are needed to reduce heterogeneity in studies on transsphenoidal pituitary adenoma surgery, according to a systematic review published in Pituitary.
“This study is a call to action for further work to develop an international, collaborative, consensus driven, common data element set for the transsphenoidal surgical management of pituitary adenoma,” Hugo Layard Horsfall, MBBS, BSc(Hons), neurosurgery registrar at Imperial College Healthcare NHS Trust in London and a research fellow in neurosurgery, robotics and artificial intelligence at University College London, and colleagues wrote. “This would likely enhance data collection, improve comparative research, reduce research inefficiency and lead to improved patient outcomes.”
Researchers conducted a systematic review of the MEDLINE and Embase databases of randomized controlled trials, prospective cohort studies and retrospective studies reporting on patients who underwent operative transsphenoidal intervention for a pituitary adenoma that were published from 1990 to 2021. Researchers obtained study details, study design, patient demographic variables, tumor histopathology, preoperative imaging and baseline clinical presentation variables.
The review included 178 studies with 427,659 participants. Of the studies, 66% were prospective, 29% were retrospective and 5% were randomized controlled trials. There were 14 studies published from 1990 to 1999, 36 published from 2000 to 2009 and 129 published from 2010 to 2021. Of the studies, 25% reported comorbidities and 24% reported whether a participant had previous pituitary adenoma surgery. BMI was reported in 12% of studies and ethnicity in 9%.
In a review of baseline variables, 56% of studies reported endocrine variables, 44% collected evidence of hormonal hypersecretion and 17% discussed hormonal hyposecretion. Of 88 studies including both functioning and nonfunctioning adenomas, 46% mentioned endocrine testing and 39% described the specific test that was performed; 27% defined hormone concentration, 7.3% reported if a person needed preoperative hormonal replacement due to hormonal deficits and 13% detailed where a person required medical suppression therapy.
Among ophthalmic variables, visual fields were reported in 34% of studies and visual acuity in 18%. Nasal variables were reported in 7% of studies.
Preoperative imaging was reported in 74% of studies. Of studies that reported imaging, 67% examined MRI alone, 25% reported CT and MRI and 2% reported CT alone.
A higher proportion of studies published from 1993 to 1998 reported on study design (100% vs. 86%), patient demographics (92% vs. 88%), clinical presentation (69% vs. 51%) and preoperative imaging (77% vs. 62%) compared with studies published from 2016 to 2021. A higher proportion of studies published in 2016 to 2021 reported tumor pathology (88% vs. 85%), endocrine variables (54% vs. 31%) and perioperative variables (87% vs. 77%) compared with studies from 1993 to 1998.
According to the authors, the National Institute of Neurological Disorders and Stroke created a common data elements project in 2006 to develop standards for performing neuroscience-related clinical research. The researchers said common data elements are needed to better standardize pituitary adenoma research moving forward.
“Despite the exponential increase in research, there remain common issues that are poorly quantified,” the researchers wrote. “These high-quality studies require a common language, such as common data elements, to help facilitate study design. Similarly, standardized endocrine baseline variable reporting would be beneficial.”
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