Clinical Characteristics and Treatment Outcome of 485 Patients with Nonfunctioning Pituitary Macroadenomas

Abstract

Background. Nonfunctioning pituitary adenomas (NFPAs) are the most common benign lesions of the pituitary gland. Objective. To describe our experience with the management of NFPA. Study Design and Methods. Retrospective evaluation of NFPA patients managed between 2008 and 2013. We analyzed data regarding clinical presentation, imaging diagnosis, hormonal status, surgical, radiotherapeutic, and pharmacological treatment, and outcome. Results. 485 patients (54% men, mean age 53 ± 14 years) were followed for a median of 6.5 years. Visual field abnormalities and headaches were the presenting complaints in 87% and 66%, respectively. The diagnosis of NFPA was made incidentally in 6.2%, and 8% presented with clinical evidence of apoplexy. All patients harbored macroadenomas, with a median volume of 10306 mm3; 57.9% had supra- or parasellar invasion and 19.6% had tumors larger than 4 cm. Central hypothyroidism, hypogonadism, and hypocortisolism were present in 47.2%, 35.9%, and 27.4%, respectively. Surgical resection was performed at least once in 85.7%. Tumor persistence was documented in 27% and was related to the size and invasiveness of the lesion. In selected cases, radiotherapy proved to be effective in controlling or preventing tumor growth. Conclusions. The diagnosis and treatment of NFPA are complex and require a multidisciplinary approach.

Characteristics and outcome of surgically treated pituitary tumours in South Africa: a single‐centre experience

“…Compressive manifestations (headache and visual disturbances) were the primary presenting symptoms in the majority of our patients, confirming the classical and relatively late presentation of the adenomas. In our study, 84·1% presented with headache and 78·3% of the patients had presented with visual disturbances, of whom 58% had VF defects; this is in keeping with available literature which reports headaches in 40–60% and visual field defects in 37–96% of patients with nonfunctioning pituitary adenomas (NFPAs) …”

“…[19][20][21][22] By contrast, in other studies, macroadenomas represented the majority (92-97%). 23,24 Consistent with available literature, 12,13 TSS was the most frequently employed approach (81Á4%) at our institution. Only 10% initially had trans-cranial surgery, and 8Á6% needed to undergo both approaches.…”

“…Consistent with available literature, TSS was the most frequently employed approach (81·4%) at our institution. Only 10% initially had trans‐cranial surgery, and 8·6% needed to undergo both approaches.…”

“…It is well known that immunohistochemical analysis of NFPAs reveals that a significant proportion of these tumours do in fact synthesize pituitary hormones despite the absence of a clinically apparent endocrine hypersecretion syndrome . This was the case in our study where the majority stained for FSH (50·9%) and LH (60%) and only a few of the tumours were positive for GH, prolactin, TSH and ACTH.…”

“…In our study, 84Á1% presented with headache and 78Á3% of the patients had presented with visual disturbances, of whom 58% had VF defects; this is in keeping with available literature which reports headaches in 40-60% and visual field defects in 37-96% of patients with nonfunctioning pituitary adenomas (NFPAs). 6,[13][14][15] Hypopituitarism was also not uncommon at presentation, occurring in 20% in this study. Available reports on frequency of hypopituitarism at presentation are variable with some studies reporting high rates (35-85%) and other studies reporting lower rates (0-41%).…”