Giant Non-Functioning Pituitary Adenoma: Clinical Characteristics and Therapeutic Outcomes

2020 ◽  
Author(s):  
Pedro Iglesias ◽  
Karina Arcano ◽  
Vanessa Triviño ◽  
Fernando Guerrero-Pérez ◽  
Víctor Rodríguez Berrocal ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Characteristics ◽  
Tumor Resection ◽  
Visual Field Defects ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Giant Pituitary Adenoma ◽  
Female Sex ◽  
Therapeutic Outcomes ◽  
Tumor Persistence

Abstract Background Giant pituitary adenoma (≥4 cm) is a rare tumor whose clinical features and prognosis are not well known. Aim To evaluate the clinical characteristics and therapeutic outcomes of giant non-functioning PA (gNFPA). Patients and Methods A retrospective multicenter study of gNFPA patients diagnosed in a 12-year period was performed. In each patient, clinical data and therapeutic outcomes were registered. Results Forty patients (24 men, age 54.2 ± 16.2 years) were studied. The maximum tumor diameter [median (interquartile range)] was 4.6 cm (4.1–5.1). Women had larger tumors [4.8 cm (4.2–5.4) vs. 4.5 cm (4.0–4.9); p=0.048]. Hypopituitarism [partial (n=22, 55%) or complete (n=9, 22.5%)] at diagnosis was present in 77.5% of the patients. Visual field defects were found in 90.9%. The most used surgical technique was endoscopic endonasal transsphenoidal (EET) surgery (n=31, 77.5%). Radiotherapy was used in 11 (27.5%) patients (median dose 50.4 Gy, range 50–54). Thirty-seven patients were followed for 36 months (10–67 months). Although more than half of these patients showed tumor persistence (n=25, 67.6%), tumor size was significantly reduced [0.8 cm (0–2.5); p<0.001]. At last visit, 12 patients (32.4%) showed absence of tumor on MRI. Hypopituitarism rate was similar (75.0%), although with significant changes (p<0.001) in the distribution of the type of hypopituitarism. The absence of tumor at the last visit was positively associated with positive immunohistochemical staining for FSH (p=0.01) and LH (p=0.006) and negatively with female sex (p=0.011), cavernous sinus invasion (p=0.005) and the presence of Knosp grade 4 (p=0.013). Conclusion gNFPAs are more frequent in men but tumors are larger in women. Surgical treatment is followed by a complete tumor resection rate of approximately 30%. Positive immunostaining for gonadotropins is associated with tumor absence at last revision, while female sex and invasion of the cavernous sinuses with tumor persistence.

scholarly journals Combined simultaneous endoscopic endonasal and microscopic transventricular surgery using a port retractor system for giant pituitary adenoma: A technical case report

2021 ◽  
Vol 12 ◽  
pp. 90
Author(s):  
Erika Yamada ◽  
Hiroyoshi Akutsu ◽  
Hiroyoshi Kino ◽  
Shuho Tanaka ◽  
Hidetaka Miyamoto ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Tumor Resection ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Giant Pituitary Adenoma ◽  
The Third ◽  
Memory Disturbance

Background: We report a case of a giant pituitary adenoma with marked extension into the third ventricle that was successfully removed using combined simultaneous endoscopic endonasal surgery (EES) and microscopic transventricular port surgery. Case Description: A 47-year-old woman, who complained of memory disturbance, had a giant pituitary adenoma with marked extension into the third ventricle that was causing obstructive hydrocephalus. She underwent combined EES and microscopic transventricular surgery using a port retractor system. Most of the tumor was resected from the EES side with assistance from the transcranial side with minimum cortical trajectory damage. The tumor was completely excised without any complications. Conclusion: For giant pituitary adenoma with marked extension into the third ventricle, combined simultaneous EES and transventricular surgery using a port retractor system is effective to maximize the extent of tumor resection while also preventing complications. Using port surgery on the transcranial side, microscopic secure dissection is possible with minimum additional cortical damage.

scholarly journals Pituitary Adenomas: Presentations and Outcomes in a South Asian Country

2008 ◽  
Vol 35 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Muhammad Shahzad Shamim ◽  
Muhammad Ehsan Bari ◽  
Faraz Khursheed ◽  
Rashid Jooma ◽  
Syed Ather Enam
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Hormone Replacement ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Asian Country ◽  
Developed Countries ◽  
P Value ◽  
Tumor Diameter ◽  
Giant Pituitary Adenoma

Objective:: The purpose of this retrospective review of all operated cases of pituitary adenomas in the last decade, is to define the demographic patterns and characteristics of such tumors and to assess surgical outcomes with regards to safety and efficacy of trans–sphenoidal tumor removal in our institution.Methods:Surgically treated pituitary adenomas presenting from 1995 till 2005 were reviewed for different variables. Results were expressed as mean, standard deviation and median for continuous and number with percentage for categorical data. Chi square test was applied to measure differences and significance was taken at p value < 0.05.Results:One hundred and twenty–five patients were operated for pituitary adenoma. Sixty–three percent were male and mean age was 37 years. Sixty percent of the patients presented with headache and/or visual symptoms. Twelve percent presented with pituitary apoplexy and 28% presented with symptoms due to pituitary hyperfunction. Fifty–five percent of patients had functioning and 44% had nonfunctioning adenomas. Mean pre operative tumor diameter from 86 pre op MRI scans was 26.76 mm (3–78 mm). Eighty–four percent of patients underwent trans–sphenoidal tumor resection and three percent had craniotomy. Mean size of post op residual tumor as calculated from 76 available post operative scans was 5.3 mm (range 0–31 mm). 17.6% of the patients required hormone replacement beyond three months and 10% were re–operated. Overall mortality was 1.6%.Conclusion:In Pakistan, patients are more likely to present either with apoplexy or with a giant pituitary adenoma than patients reported from developed countries. Overall, our results have been satisfactory and comparable with the literature.

NCOG-31. GIANT PITUITARY ADENOMA (GPA) SCORE: A NOVEL SCORING SYSTEM TO PREDICT POSTOPERATIVE OUTCOMES OF GIANT PITUITARY ADENOMAS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi158-vi158
Author(s):  
Syed Ather Enam ◽  
Fauzan Alam Hashmi ◽  
Sanam Mir Ghazi ◽  
Ahsan Ali Khan ◽  
Muhammad Bilal Tariq ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Linear Regression ◽  
Pituitary Adenomas ◽  
Scoring System ◽  
Tumor Resection ◽  
Maximum Diameter ◽  
Giant Pituitary Adenoma ◽  
Giant Pituitary Adenomas ◽  
The Mean ◽  
Suprasellar Extension

Abstract BACKGROUND Giant pituitary adenomas (GPA) are uncommon and highly variable in morphology and extension. There is no scoring system that considers all the dimensions of adenoma invasion. We developed a new Giant Pituitary Adenoma score and report our surgical experience and evaluate outcomes after resection of these tumors in accordance with the preoperative score. METHODS We developed a novel scoring system for classifying giant pituitary adenomas, and 11-year data of GPA surgery at our center was collected retrospectively, based on this scoring system. GPA Score considered tumor’s parasellar extension, encasement of cavernous internal carotid artery (ICA), suprasellar extension &gt; 2 cm, suprasellar extension &gt; 4cm and retrosellar extension. Maximum possible score was 9. The scoring system was applied to 53 patients of GPA who underwent surgical resection between January 1, 2006, and December 2017. The Lundin-Pederson (ABC/2) method was used to calculate the tumor volume both pre- and post-resection and linear regression was used to assess the relationship between extent of tumor resection and GPA score. RESULTS The median age of the study population was 42.08 ± 16.49 years. The mean maximum diameter of the pituitary adenomas was 5.0 cm (range 4.0 cm-8.5cm) while the mean volume of the adenomas was 27.3 cm3 (range 10 cm3-149 cm3). There were 3 cases of score 2, 5 cases of score 3, 13 cases of score 4, 20 cases of score 5, 9 cases of score 6 and 3 cases of score 7. The range of tumor volumes of tumors for scores from 2-7 was 17.3 cm3 to 65.8 cm3 and GPA score was correlated with the percent residual tumor using linear regression that was statistically significant (p= 0.001). CONCLUSION GPA Score is a reliable scoring system to predict the extent and subsequent difficulty in tumor resection in GPA.

scholarly journals Giant Non-Functioning Pituitary Adenoma: Clinical Characteristics and Therapeutic Outcomes

2020 ◽  
Author(s):  
Pedro Iglesias ◽  
Karina Arcano ◽  
Vanessa Triviño ◽  
Fernando Guerrero-Pérez ◽  
Víctor Rodríguez Berrocal ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Characteristics ◽  
Therapeutic Outcomes

scholarly journals Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly

2020 ◽  
Vol 48 (6) ◽  
pp. E10 ◽  
Author(s):  
Tyler Cardinal ◽  
Martin J. Rutkowski ◽  
Alexander Micko ◽  
Mark Shiroishi ◽  
Chia-Shang Jason Liu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Medical Therapy ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cranial Nerves ◽  
Elevated Serum ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Csf Leakage

OBJECTIVEAcromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor–1 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.METHODSThe authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.RESULTSThe 52 patients had a mean age of 50.7 ± 13.4 years and a mean follow-up duration of 24.4 ± 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.CONCLUSIONSEndoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.

Evaluation of Pure Endoscopic Endonasal Approach in Management of Giant Pituitary Adenoma

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mina M Gerges ◽  
Hatem Sabry ◽  
Hasan Jalalod din ◽  
Mohamed Ashraf Ghobashy ◽  
Theodore H Schwartz
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Giant Pituitary Adenoma ◽  
Postoperative Hematoma ◽  
Extended Transsphenoidal Approach

Abstract Background Giant pituitary adenoma represents one of the challenging tumor for neurosurgeons. Many microsurgical approaches in the past were used for its management. Recently and with evolution of the endoscopic equipment and instruments, extended endoscopic transsphenoidal approach become one of the preferable approaches for its surgical excision. Methods We prospectively document the clinical , surgical and follow up data for all patients presented with giant pituitary adenoma to Ain-Shams university hospital and Weill Cornell Medical College, Presbyterian hospital and were surgically treated with extended transsphenoidal approach from 2015 till 2019. Results Our group study formed of 44 patients with mean age 53.03 (range 14.7-82.4) and a male predominance (59%). The main presentation was visual problems in 75% followed by partial hypopituitarism in 31.81% while headache was in 13.64%. Only 4 patients had functioning adenoma (3 prolactinoma and 1 acromegaly). Average tumor volume was 26.95 ± 17.25 cm3, while the mean maximum tumor diameter was 4.73 cm (range 4.0-8.0 cm). Radiographic invasion was found in 97.73% to suprasellar cistern, 61.36% to the cavernous sinus and in 34% to the sphenoid sinus. GTR was achieved in 45.45% with Knosp score is the only significant predictor factor for resection rate (p = 0.04). Visual improvement achieved in 75.76%. 50% (2 patient) of the patients with functioning adenoma were cured. Complications included CSF leak in 3 patients, permanent DI in 4 patients and postoperative hematoma in 2 patients. Recurrence and progression rates without upfront radiation therapy were 5.00 % and 31.81% respectively after mean follow up period 57.90 months. Conclusions Extended endoscopic approaches for achieving maximum resection with minimal morbidity for giant pituitary adenoma are very effective. Lateral tumor extension with cavernous sinus invasion represents the limiting point in achieving gross total resection. Upfront radiation therapy for patients with residual adenoma can be avoided but regular follow up should be warranted.

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