Tumores neuroendócrinos pituitários: análise epidemiológica retrospectiva de uma série de casos em um centro terciário brasileiro

Abstract

Background: PitNETs are the most common neoplasms arising in the sellar region and display considerable clinical and histopathological heterogeneity. In Brazil, detailed epidemiological data from surgical series in public tertiary centers remain scarce. Objective: To describe the demographic, clinical, volumetric, and histopathological profile of patients undergoing surgery for PitNETs in a Brazilian tertiary center and to explore associations between tumor subtype, symptoms, and tumor volume. Methods: This was a retrospective, observational, consecutive case series including patients with sellar lesions operated between January 2015 and August 2025 at HUCFF, with histopathological confirmation of pituitary adenoma. Demographic, clinical, volumetric, and histopathological data were obtained through chart review. Statistical analyses were performed using Jamovi 2.6, employing Student’s t test, Mann–Whitney U test, Kruskal–Wallis test, chi-square test, with a significance level of p < 0,05 and an exploratory approach. Results: Of 57 patients evaluated, 52 met inclusion criteria; 59.6% were women, and the mean age at diagnosis was 51 years (SD 17). Macroadenomas predominated (95%), with microadenomas in 5% of cases. Gonadotroph tumors were the most frequent subtype (44%), followed by corticotroph and null cell tumors (15% each). Visual complaints were present in 71% of patients and headache in 60%. In the volumetric subset (n = 13), median tumor volume was 8.70 cm³ (IQR 3.30–16.3), with larger volumes in women compared with men (10.4 vs. 2.8 cm³; p = 0.045). There was no association between sex and histological subtype (p = 0.371), nor significant age differences across subtypes (p = 0.195). A global association between histological subtype and visual symptoms was observed (p = 0.048), but adjusted residuals did not identify any single subtype with a disproportionate contribution. Patients with headache were older than those without this complaint (p = 0.006). Conclusion: This series shows a predominance of symptomatic macroadenomas, with high rates of visual deficits and a predominance of gonadotroph tumors, in line with international surgical cohorts. The findings suggest that clinical presentation is more closely related to tumor volume and mass effect than to functional subtype alone. Limitations related to the retrospective, singlecenter design, reliance on chart data, absence of transcription factor markers, and the small volumetric subset indicate that the results should be interpreted as exploratory and hypothesisgenerating, underscoring the need for prospective, multicenter studies with more comprehensive pathological characterization in the Brazilian setting.