Presenting Features in 269 Patients With Clinically Nonfunctioning Pituitary Adenomas Enrolled in a Prospective Study

Abstract Context Clinically nonfunctioning pituitary adenomas (CNFPAs) typically remain undetected until mass effect symptoms develop. However, currently, head imaging is performed commonly for many other indications, which may increase incidental discovery of CNFPAs. Since current presentation and outcome data are based on older, retrospective series, a prospective characterization of a contemporary CNFPA cohort was needed. Objective To determine the prevalence of incidental presentation and hypopituitarism and its predictors in a CNFPA cohort that spanned 6 to 9 mm micro- to macroadenoma included observational and surgical therapy. Methods At enrollment in a prospective, observational study, 269 patients with CNFPAs were studied by history, examination, blood sampling, and pituitary imaging analysis and categorized into incidental or symptoms presentation groups that were compared. Results Presentation was incidental in 48.7% of patients and due to tumor symptoms in 51.3%. In the symptoms and incidental groups, 58.7% and 27.4% of patients had hypopituitarism, respectively, and 25% of patients with microadenomas had hypopituitarism. Many had unappreciated signs and symptoms of pituitary disease. Most tumors were macroadenomas (87%) and were larger in the symptoms than incidental and hypopituitary groups than in the eupituitary groups. The patients in the incidental group were older, and males were older and had larger tumors in both the incidental and symptoms groups. Conclusions Patients with CNFPAs commonly present incidentally and with previously unrecognized hypopituitarism and symptoms that could have prompted earlier diagnosis. Our data support screening all large micro and macro-CNFPAs for hypopituitarism. Most patients with CNFPAs still have mass effect signs at presentation, suggesting the need for more awareness of pituitary disease. Our ongoing, prospective observation of this cohort will assess outcomes of these CNFPA groups.

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Clinically nonfunctioning pituitary tumours and gonadotropinomas

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.2158 ◽

2011 ◽

pp. 209-218 ◽

Cited By ~ 1

Author(s):

W. W. de Herder ◽

R. A. Feelders ◽

A. J. van der Lely

Keyword(s):

Medical Treatment ◽

Pituitary Adenomas ◽

Clinical Signs ◽

Signs And Symptoms ◽

Mass Effect ◽

Tumour Resection ◽

Ovarian Activity ◽

Pituitary Tumours ◽

Term Outcome ◽

Nonfunctioning Pituitary Adenomas

The significant progress that has been made in the past years in the medical treatment of all pituitary adenomas is in stark contrast with the lack of progress in the medical treatment of clinically nonfunctioning pituitary tumours, or adenomas. In fact, only secreting, or functioning, tumours can be treated by medical therapy with at least modest to very impressive effect. Clinically nonfunctioning pituitary adenomas do not produce clinical signs of hormonal hypersecretion. Therefore, signs and symptoms will depend on the mass effect of these adenomas over the central nervous system (1–3). Due to the lack of hypersecretion of hormones, nonfunctioning pituitary adenomas present themselves because of their mass effect and compression or destruction of surrounding tissues. This could also lead to hypopituitarism, which can be the presenting symptom as well (1–3). Despite their histologically benign nature, giant and ‘invasive’ nonfunctioning pituitary adenomas are one of the most complex neurosurgical challenges. Large nonfunctioning pituitary tumours are usually confined inferiorly by the sellar dura, superiorly by the elevated sellar diaphragm, and laterally by an intact medial wall of the cavernous sinus. If the anatomical extensions of the tumour are understood and a radical tumour resection is achieved, the visual and long-term outcome can be very rewarding. The goals of surgery are twofold: first to make a pathological diagnosis, and second, because these tumours are endocrinologically silent, to decompress the neural tissue (4). The vast majority of nonfunctioning pituitary adenomas are gonadotroph cell adenomas, as demonstrated by immunocytochemistry. However, they are rarely associated with increased levels of dimeric luteinizing hormone or follicle-stimulating hormone. Increased levels of subunits (free α‎-subunit mainly, LH-B subunit more rarely), however, are more frequently encountered, but are generally modest (5). In this chapter the term ‘clinically nonfunctioning pituitary adenomas’ is used to describe pituitary tumours, which in most instances produce low quantities of hormones causing no clinically recognizable symptomatology. In the few instances, in which such tumours produce intact gonadotropins that activate testicular or ovarian activity, the term ‘gonadotropinomas’ is used.

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Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas

Journal of Neurosurgery ◽

10.3171/2013.11.jns131757 ◽

2014 ◽

Vol 120 (3) ◽

pp. 647-654 ◽

Cited By ~ 30

Author(s):

Cheng-Chia Lee ◽

Hideyuki Kano ◽

Huai-Che Yang ◽

Zhiyuan Xu ◽

Chun-Po Yen ◽

...

Keyword(s):

Gamma Knife ◽

Pituitary Adenomas ◽

Gamma Knife Radiosurgery ◽

Outcome Data ◽

Tumor Control ◽

Surgical Removal ◽

Tumor Margin ◽

Tumor Control Rate ◽

Nonfunctioning Pituitary Adenomas

Object Nonfunctioning pituitary adenomas (NFAs) are the most common type of pituitary adenoma and, when symptomatic, typically require surgical removal as an initial means of management. Gamma Knife radiosurgery (GKRS) is an alternative therapeutic strategy for patients whose comorbidities substantially increase the risks of resection. In this report, the authors evaluated the efficacy and safety of initial GKRS for NFAs. Methods An international group of three academic Gamma Knife centers retrospectively reviewed outcome data in 569 patients with NFAs. Results Forty-one patients (7.2%) underwent GKRS as primary management for their NFAs because of an advanced age, multiple comorbidities, or patient preference. The median age at the time of radiosurgery was 69 years. Thirty-seven percent of the patients had hypopituitarism before GKRS. Patients received a median tumor margin dose of 12 Gy (range 6.2–25.0 Gy) at a median isodose of 50%. The overall tumor control rate was 92.7%, and the actuarial tumor control rate was 94% and 85% at 5 and 10 years postradiosurgery, respectively. Three patients with tumor growth or symptom progression underwent resection at 3, 3, and 96 months after GKRS, respectively. New or worsened hypopituitarism developed in 10 patients (24%) at a median interval of 37 months after GKRS. One patient suffered new-onset cranial nerve palsy. No other radiosurgical complications were noted. Delayed hypopituitarism was observed more often in patients who had received a tumor margin dose > 18 Gy (p = 0.038) and a maximum dose > 36 Gy (p = 0.025). Conclusions In this study, GKRS resulted in long-term control of NFAs in 85% of patients at 10 years. This experience suggests that GKRS provides long-term tumor control with an acceptable risk profile. This approach may be especially valuable in older patients, those with multiple comorbidities, and those who have endocrine-inactive tumors without visual compromise due to mass effect of the adenoma.

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Objective criteria for successful transsphenoidal removal of suprasellar nonfunctioning pituitary adenomas. A prospective study

Acta Neurochirurgica ◽

10.1007/s00701-006-1044-6 ◽

2006 ◽

Vol 149 (1) ◽

pp. 21-29 ◽

Cited By ~ 39

Author(s):

J. Honegger ◽

U. Ernemann ◽

T. Psaras ◽

B. Will

Keyword(s):

Prospective Study ◽

Pituitary Adenomas ◽

Nonfunctioning Pituitary Adenomas ◽

A Prospective Study

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A prospective study of nonfunctioning pituitary adenomas: presentation, management, and clinical outcome

Journal of Neuro-Oncology ◽

10.1007/s11060-010-0302-x ◽

2010 ◽

Vol 102 (1) ◽

pp. 129-138 ◽

Cited By ~ 74

Author(s):

Lukui Chen ◽

William L. White ◽

Robert F. Spetzler ◽

Bainan Xu

Keyword(s):

Clinical Outcome ◽

Prospective Study ◽

Pituitary Adenomas ◽

Nonfunctioning Pituitary Adenomas ◽

A Prospective Study

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Contribution of immunohistochemistry, electron microscopy, and cell culture to the characterization of nonfunctioning pituitary adenomas: A study of 40 cases

Human Pathology ◽

10.1016/0046-8177(92)90051-4 ◽

1992 ◽

Vol 23 (12) ◽

pp. 1332-1339 ◽

Cited By ~ 15

Author(s):

Anne Croue ◽

Veronique Beldent ◽

Marie-Christine Rousselet ◽

Gilles Guy ◽

Vincent Rohmer ◽

...

Keyword(s):

Electron Microscopy ◽

Cell Culture ◽

Pituitary Adenomas ◽

Nonfunctioning Pituitary Adenomas

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Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas

Journal of Neurosurgery ◽

10.3171/jns.1986.64.5.0713 ◽

1986 ◽

Vol 64 (5) ◽

pp. 713-719 ◽

Cited By ~ 222

Author(s):

Michael J. Ebersold ◽

Lynn M. Quast ◽

Edward R. Laws ◽

Berndt Scheithauer ◽

Raymond V. Randall

Keyword(s):

Pituitary Adenomas ◽

Mass Effect ◽

Pituitary Hormones ◽

Long Term Results ◽

Null Cell ◽

Content Type ◽

Nonfunctioning Pituitary Adenomas ◽

Presenting Symptoms

✓ Little has been written about the long-term results of transsphenoidal treatment for clinically nonfunctioning pituitary adenomas. The records of 100 patients who had undergone a transsphenoidal procedure for excision of such tumors were reviewed. Immunocytology for pituitary hormones was performed in all cases. The group consisted predominantly of null-cell adenomas, although a small number of prolactinomas and gonadotropic tumors were found. The mean diameter of the tumors at the time of detection was slightly more than 2 cm. In most cases, the presenting symptoms were due to the mass effect of the tumor (that is, visual symptoms in 72 patients, hypopituitarism in 61, headache in 36, and cranial nerve disturbance other than visual loss in 10). Radiation therapy was recommended for patients in whom subtotal removal of the adenoma was expected. Six patients developed symptomatic tumor recurrence, and 10 patients demonstrated radiographic recurrence during the 48 to 100 months (mean 73.4 months) of follow-up observation. Only three of 10 deaths during the follow-up period were due to pituitary disease or treatment.

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