Natural History of Nonfunctioning Pituitary Adenomas and Incidentalomas: A Systematic Review and Metaanalysis

Fernández-Balsells, Mercè; Murad, M. Hassan; Barwise, Amelia; Gallegos‐Orozco, Juan F.; Paul, Anu; Lane, Melanie A.; Lampropulos, Julianna F.; Natividad, Inés; Perestelo-Pérez, Lilisbeth; León-Lovatón, Paula G. Ponce de; Erwin, Patricia J.; Carey, Jantey; Montori, Víctor M.

doi:10.1210/jc.2010-1054

Cited by 189 publications

(168 citation statements)

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“…However, by reviewing the literature on the natural history of untreated symptomatic NFPA and incidentally discovered NFPA, the rate of tumor growth during the follow-up period ranged from 7 to 50% (3,4,5,6,8,9,19,33,34,35). Furthermore, in their metaanalysis Fernández-Balsells et al (17) estimated that during the follow-up the tendency of tumor growth was 12.5% per year (95% CI 7.9-17.2%), the risk of new endocrine dysfunction was 2.4% per year (95% CI 0.0-6.4%), and the risk of worsening of the visual field was 0.65% per year (95% CI 0.47-0.82%). Therefore, our results can reassure patients who choose surgical removal of asymptomatic and incidentally discovered NFPA that early and late outcome is very good at the expense of minimal risks of the surgical procedure, including a low risk of developing new pituitary deficiencies.…”

Section: Surgery For Pituitary Incidentalomasmentioning

confidence: 99%

“…Surgery is usually advised also in asymptomatic patients with tumors that abut the optic chiasm (15). In older patients without visual deficit, a more conservative approach might be preferred (16,17). Even in patients with asymptomatic NFPA, immediate surgery might be considered, but most authors recommend clinical and neuroradiological follow-up as first option (15,18,19).…”

Section: Introductionmentioning

confidence: 99%

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Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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Objective: Few data are available on the surgical results in patients with incidentally discovered nonfunctioning pituitary adenoma (NFPA). We investigated the efficacy and safety of surgery in patients with incidentally discovered NFPA. Design: Retrospective analysis of prospectively recorded outcomes. Methods: From 1990 to 2011, of 804 consecutive patients undergoing surgery for NFPA, 212 cases had an incidentally discovered tumor (26.4%). Among them, 117 patients were asymptomatic, while 95 had some visual and/or hormonal deficit. The main outcome of the study was to evaluate the frequency of radical resection as judged on the first postoperative neuroimaging study and detection of recurring disease during long-term follow-up. Results: Postoperative residual tumor was detected in 8.9% of patients with asymptomatic incidentalomas as compared with 31.2% of patients with symptomatic incidentalomas (P!0.001) and 41.2% of patients in the control group (P!0.001). Multivariate analysis confirmed that having an asymptomatic incidentaloma was independently associated with a better outcome. The 5-year recurrence-free survival in patients with incidentaloma was 86.8% (95% CI 80.2-92.4%) as compared with 77.9% (95% CI 73.6-82.2%; P!0.01) in the control group. This difference was almost completely due to a lower frequency of relapse in asymptomatic patients. Multivariate analysis confirmed the independent lower risk of tumor recurrence in asymptomatic NFPA. Conclusion: Our study shows for the first time that surgically treated patients with asymptomatic NFPA have a better early and long-term outcome that is independent from all the other demographic, clinical, and morphologic characteristics of the patients.

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Section: Surgery For Pituitary Incidentalomasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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“…9,22,34,43,46,48 In a recent metaanalysis of the natural history of nonfunctioning pituitary adenomas, the incidence of growth in macroadenomas was reportedly 12.53 per 100 person-years. 18 Two years prior, O'Sullivan et al found that 33.5% of 159 patients with nonfunctioning adenomas who underwent resection, but not postoperative radiation therapy or radiosurgery, demonstrated evidence of recurrence or growth at a median follow-up of 4.1 years (range 1-20.7 months). The 5-and 10-year actuarial rates of recurrence or growth of residual adenoma were 24.4% and 51.5%, respectively.…”

mentioning

confidence: 99%

Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Pomeraniec¹,

Dallapiazza²,

Xu³

et al. 2016

JNS

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N oNfuNctioNiNg pituitary adenomas constitute approximately 15% to 30% of pituitary tumors 10,16 and typically present with symptoms of mass effect, including vision loss, headaches, and hypopituitarism from compression of the normal pituitary gland. Selective adenomectomy via a transsphenoidal approach remains the primary treatment modality by providing decompression and the prospect for cure. Complete resection rates vary significantly and can be limited due to tumor size and propensity for microscopic invasion of the surrounding structures. 2,5,31,32,43,56 Previously reported long-term outcomes following transsphenoidal surgery for nonfunctioning macroadenomas suggest that even gross-total resection carries a 10% to 20% rate of tumor recurrence at distant follow-up. 6,8,9,13,19,21,34,43,46,58,64,66 Subtotal resection without adjuvant treatment reportedly results in the progression of adenoma growth in 50% to 60% of patients within 10 years of surgery. 9,22,34,43,46,48 For these reasons, patients with nonfunctioning tumors may undergo secondary operations and/ or adjuvant radiotherapy for the treatment of residual or progressive disease. obJective Gamma Knife radiosurgery (GKRS) is frequently employed to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of radiographic progression of tumor. methods This is a retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS between 1996 and 2013 at the University of Virginia Health System. Patients were stratified based on the interval between resection and radiosurgery. Operative results and imaging and clinical outcomes were compared across groups following early (≤ 6 months) or late (> 6 months) radiosurgery. results Sixty-four patients met the study criteria and were grouped based on early (n = 32) or late (n = 32) GKRS following transsphenoidal resection. There was a greater risk of tumor progression after GKRS in the late radiosurgical group (p = 0.027) over a median radiographic follow-up period of 68.5 months. Furthermore, there was a significantly higher occurrence of post-GKRS endocrinopathy in the late radiosurgical cohort (p = 0.041). Seventeen percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 64% in the late cohort (p = 0.036). This difference was primarily due to a significantly higher rate of tumor growth during the observation period of the late treatment cohort (p = 0.014). Of these patients with completely new endocrinopathies, radiation-associated pituitary insufficiency developed in 1 of 2 patients in the early group and in 3 of 7 (42.9%) patients in the late group. coNclusioNs Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared w...

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“…Diagnosis is usually established by detecting the predominant complications of neurological character, perhaps some degree of hypopituitarism, headache, and other clinical manifestations induced by the unpredictable biological behavior of those tumors. Prevalence of specific cellular lineage varies, but is has been calculated to be as 7 to 9 cases out of 100,000 inhabitants, including the silent gonadotrope, corticotrope, thyrotrope, oncocytic, null cell, lactotrope, and other silent cellular lineages [4,9]. In contrast to these data, a higher prevalence was registered in Belgium with a figure of 94 patients out of 100,000 people [10].…”

Section: Introductionmentioning

confidence: 97%

“…An early diagnosis is obtained in the case of female patients [5] as reported by Nabarro [6]. The non-functioning pituitary adenomas are a heterogeneous subset of neoplasms of monoclonal origin of the adenohypophysis [7], which constitute 25-30% of pituitary neoplasias [8,9]. Diagnosis is usually established by detecting the predominant complications of neurological character, perhaps some degree of hypopituitarism, headache, and other clinical manifestations induced by the unpredictable biological behavior of those tumors.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Neurological Manifestations of Non-Functioning Pituitary Adenomas (NFPA). Is it ok to Suspect an Early Invasiveness?

Sánchez-Turcios¹,

Rangel-Morales²,

Fj³

2015

EMIJ

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Introduction: Clinically non-functioning pituitary adenomas (NFPA) are a heterogeneous set of complex adenomas with a wide variety of immunohistochemical subtypes such as silent gonadotrope, null cell adenoma, silent corticotrope adenoma, and other silent tumors of somatotrope, thyrotrope, and lactotrope lineages. The diagnosis is established by hypothalamus-pituitary MRI, which gives the volume of the tumor, and by determining the pituitary hormones, peripheral hormones when indicated, and neurologic manifestations. In NPFA, there is neither a typical hormonal hyper secretion nor a determined clinical syndrome.

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Natural History of Nonfunctioning Pituitary Adenomas and Incidentalomas: A Systematic Review and Metaanalysis

Abstract: Despite the relatively high prevalence of PIs/NFPAs, the evidence on the natural history of these entities is scarce and of low quality. PIs/NFPAs seem to have fairly rare complications that may be more common when lesions are large (>10 mm) and solid.

Cited by 189 publications

References 25 publications

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Clinical and Neurological Manifestations of Non-Functioning Pituitary Adenomas (NFPA). Is it ok to Suspect an Early Invasiveness?

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