Microadenomas of the Pituitary and Abnormal Sellar Tomograms in an Unselected Autopsy Series

Burrow, Gerard N.; Wortzman, G; Rewcastle, N. B.; Holgate, Richard C.; Kovács, Kálmán

doi:10.1097/00006254-198106000-00019

Cited by 71 publications

(87 citation statements)

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“…Pituitary tumours may be discovered at all ages, and in an unselected autopsy series of patients aged 16-91 years, the age distribution of patients with pituitary tumours (microadenomas) did not differ from the age distribution of the population as a whole (1). Pituitary microadenomas were found in 20/152 (13%) of pituitaries taken from an autopsy series of patients aged over 80 years (2).…”

Section: Introductionmentioning

confidence: 83%

Pituitary tumours in the elderly: a 20 year experience

Turner¹,

Adams²,

Wass³

1999

European Journal of Endocrinology

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The proportion of the elderly in the population is increasing, and the appreciation and management of medical problems in this age group will therefore become more important. We therefore decided to determine the clinical features and types of pituitary tumour presenting in the elderly, and to examine the treatment and outcome in this group. We conducted a retrospective case-note review from a specialist endocrine and neurosurgical unit in a tertiary referral centre. Eighty-four patients aged 65 years and over on diagnosis of a pituitary tumour were referred to the unit between 1975 and 1996. There were 45 males and 39 females, and the mean age was 72.4 years (range 65-86). Over half of the pituitary lesions were non-functioning adenomas (NFAs) (60.7%). GH-secreting tumours were present in 11 (13.1%) and macroprolactinomas in 7 (8.1%). Four patients had microadenomas and 17 had miscellaneous pituitary-related lesions. Visual deterioration was the commonest mode of presentation in 33 (39.3%), but 54 (64.3%) had evidence of visual impairment on detailed examination. Despite the majority of patients (80.8%) having coexisting medical conditions, trans-sphenoidal surgery was performed in 60 (71.4%) and was well tolerated with a zero peri-and post-operative mortality rate, and post-operative complications in 11 (13.1%).Pituitary tumours in the elderly are most frequently NFAs that present with visual deterioration and hypopituitarism. The fact that 46.5% were pan-hypopituitary on diagnosis and that 64.3% of patients had visual impairment suggests a delay in diagnosis in this age group. Despite significant coexisting medical pathology in this large series of patients, surgery was safe and successful in the majority.

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Section: Introductionmentioning

confidence: 83%

Pituitary tumours in the elderly: a 20 year experience

Turner¹,

Adams²,

Wass³

1999

European Journal of Endocrinology

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“…Using MRI, silent pituitary adenomas are found in 10% of a random adult population [3], while occult adenomas are described in a large range (3%-27%) of post mortem examinations [26].…”

Section: Discussionmentioning

confidence: 99%

A case of a GH–producing pituitary adenoma associated with a unilateral headache with autonomic signs

et al. 2005

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IntroductionTen to fifteen percent of all diagnosed cerebral tumours are pituitary adenomas (60%-70% are secreting adenomas) that frequently occur during the 3rd or 4th decades of life. Half of them are diagnosed early by clinical hormonal symptoms even when the dimensions of the adenomas are small (5 mm) and the tumours are undetected on magnetic resonance imaging (MRI) scans. Among these, however, growth hormone (GH)-producing macroadenomas are uncommon, and often have blood hormonal levels so low that their diagnosis could be delayed [1,2]. In 10% of the adult population, MRI scans can detect silent pituitary adenomas [3].Thirty-three to seventy-two percent of pituitary adenomas, independently of their dimensions, induce headache [4,5]. Headache is the first symptom in about 11% of women and in about 15% of men [6]. Some studies have suggested that the incidence of headache was 57.1% in non-functioning adenomas [7] and 60% in GH-secreting adenomas [8]. Headache seems to be more frequent in prolactin (PRL)-secreting adenomas (57.1%) than in GHsecreting adenomas (12.5%) [9]. Headache, more frequently localised to the frontal region, is bilateral (89.5%) or monolateral (84.2%) and sometimes diffuse (42.1%).Pain is continuous or pressing-heavy, and rarely pulsating-intermittent (mostly in female patients) (57.9%) [9]. Headaches due to GH-secreting adenomas, with or without acromegaly, do not have significant sellar abnormalities or visual problems [5,8]. another MRI scan of the sellar region confirmed the presence of a pituitary macroadenoma on the left paramedian side. After an initial improvement of the symptomatology due to trans-sphenoidal ablation of a benign GH-producing macroadenoma, the headache worsened again. Pain was well correlated with the increased plasma levels of IGF-1. The patient died suddenly for myocardial infarct.

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“…However, there are, in addition to the absence of hormone overproduction, arguments that in our series the vast majority of the lesions consist of NFMA. In autopsy series, pituitary lesions turn out to be non-functioning adenomas in about 50%, the other 50% mainly being hormonal active adenomas (2,29). Moreover, in the vast majority of patients, MRI can with adequate accuracy differentiate between pituitary adenomas and craniopharyngiomas (30,31) and between pituitary adenoma and pituitary hypertrophy (32).…”

Section: Non-functioning Pituitary Macroadenomasmentioning

confidence: 99%

The natural course of non-functioning pituitary macroadenomas

Dekkers¹,

Hammer²,

Keizer³

et al. 2007

eur j endocrinol

168

129

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Objective: The natural history of non-functioning pituitary macroadenomas (NFMA) has not been completely elucidated. Therefore, we evaluated pituitary function, visual fields, and tumor size during long-term follow-up of non-operated patients with NFMA. Design: Follow-up study. Patients: Twenty-eight patients (age 55G3 years) with NFMA, not operated after initial diagnosis, were included. Results: Initial presentation was pituitary insufficiency in 44%, visual field defects in 14%, apoplexy in 14%, and chronic headache in 7% of the patients. The duration of follow-up was 85G13 months. Radiological evidence of tumor growth was observed in 14 out of 28 patients (50%) after duration of follow-up of 118G24 months. Six patients (21%) were operated, because tumor growth was accompanied by visual field defects. Visual impairments improved in all the cases after transsphenoidal surgery. Spontaneous reduction in tumor volume was observed in eight patients (29%). No independent predictors for increase or decrease in tumor volume could be found by regression analysis. Conclusion: Observation alone is a safe alternative for transsphenoidal surgery in selected NFMA patients, without the risk of irreversibly compromising visual function. European Journal of Endocrinology 156 217-224

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Microadenomas of the Pituitary and Abnormal Sellar Tomograms in an Unselected Autopsy Series

Cited by 71 publications

References 0 publications

Pituitary tumours in the elderly: a 20 year experience

Pituitary tumours in the elderly: a 20 year experience

A case of a GH–producing pituitary adenoma associated with a unilateral headache with autonomic signs

The natural course of non-functioning pituitary macroadenomas

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