Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors

Abstract

Objective: The long-term outcome of non-functioning pituitary adenoma (NFPA) patients is not clearly established, probably due to the low annual incidence and prolonged natural history of these rare tumors. The aim of this study was to evaluate clinical data at presentation and long-term post-surgery and radiotherapy outcome in a cohort of patients with NFPA. Design and methods: A computerized database was developed using Access 2000 software (Microsoft Corporation, 1999). Retrospective registration of 295 NFPA patients was performed in seven Endocrinological Centers of North West Italy. Data were analyzed by STATA software. Results: The main presenting symptoms were visual defects (67.8%) and headache (41.4%) and the most frequent pituitary deficit was hypogonadism (43.3%), since almost all tumors were macroadenomas (96.5%). Surgery was the first choice treatment (98% of patients) and total debulking was achieved in 35.5%. Radiotherapy was performed as adjuvant therapy after surgery in 41% of patients. At the followup, recurrence occurred in 19.2% of patients without post-surgical residual tumor after 7.5G2.6 years, regrowth in 58.4% of patients with post-surgical remnant after 5.3G4.0 years and residue enlargement in 18.4% of patients post-surgically treated with radiotherapy after 8.1G7.3 years. Conclusions: Our database indicates that the goal of a definitive surgical cure has been achieved during the last decade in a low percentage of patients with NFPA. This tumor database may help to reduce the delay between symptom onset and diagnosis, to assess prognostic parameters for the follow-up of patients with different risk of recurrence and to define the efficacy and safety of different treatments and their association with mortality/morbidity. European Journal of Endocrinology 155 823-829

Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas

“…The slow progressive development of a lesion without functional indicators that would facilitate diagnosis seems to have led to two basic types of complaints among these patients: headache and visual disturbances. These symptoms have also been reported by other patients at the time of diagnosis 20,22 . Visual changes were present in 87.3% of the patients, given that the study population had only been referred to the hospital when they showed large lesions (average size of 3.1 cm).…”

“…In our sample, this was achieved through reduction of tumor volume and, more exceptionally, tumor exclusion. This difficulty in achieving tumor cure through surgery was also observed in 295 patients with non-functioning tumors, among whom this was achieved in only 35.5% 22 . Recurrence occurred in 19.2% of those who had no residual tumor after a mean of seven years after the surgery and in 58% of those with tumor residues after an average of five years.…”

Erdheim-Chester disease and pituitary involvement: a unique case and the literature

“…Case 1 and 6 with normal level of PRL showed hypogonadotropic hypogonadism without abnormalities in CT or MRI. In the cases of hypopituitarism caused by pituitary mass [27,28] or apoplexy [29,30], gonadotropin is known as one of the pituitary hormones that are impaired early. However, case 1 and 6 showed no abnormalities in the images, supporting the possibility that they might not have shown structural disorder due to xanthogranulomatous infiltration, but might have been reported that interferon α shows direct inhibitory effects on thyroid hormone synthesis, release, and metabolism [39].…”

Dopamine D2 receptor gene polymorphisms and response to cabergoline therapy in patients with prolactin-secreting pituitary adenomas

“…33 The database was divided into two parts: a principal table, including information about the patient at the time of recruitment, and several follow-up records. Each patient received an identification number, and personal information was available only to principal investigators or coinvestigators.…”