Non-functioning pituitary macroadenoma: surgical outcomes, tumor regrowth, and alterations in pituitary function—3-year experience from the Iranian Pituitary Tumor Registry

Najmaldin, Atousa; Malek, Mojtaba; Madani, Nahid Hashemi; Ghorbani, Mohammad; Akbari, Hamideh; Khajavi, Alireza; Qadikolaei, Omolbanin Asadi; Khamseh, Mohammad E.

doi:10.1007/s42000-019-00109-5

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…Because of the obscure symptoms of inappropriate secretion of TSH and acromegaly, the ignorance and delayed diagnosis of disease often occurs. The major manifestations of the affected gonadal axis in our patients were central hypogonadism or reduced libido in the males and menstrual disturbance in the females, which was consistent with current reports ( 11 , 14 , 26 – 28 ). In view of the exclusion of mixed prolactinoma, the pituitary stalk effect might contribute to the slight elevation of PRL in two of our patients without any symptoms or signs of hyperprolactinemia.…”

Section: Discussionsupporting

confidence: 93%

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center

Duan

et al. 2023

Front. Endocrinol.

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BackgroundGrowth hormone (GH)/thyroid stimulating hormone (TSH) cosecreting pituitary adenoma (PA) is an exceedingly rare kind of bihormonal pituitary neuroendocrine tumors (PitNETs). Its clinical characteristics have rarely been reported.ObjectivesThis study aimed to summarize the clinical characteristics and experience of diagnosis and treatment among patients with mixed GH/TSH PAs from a single center.MethodsWe retrospectively reviewed GH/TSH cosecreting PAs from 2063 patients diagnosed with GH-secreting PAs admitted to Peking Union Medical College Hospital between January 1st, 2010, and August 30th, 2022, to investigate the clinical characteristics, hormone detection, imaging findings, treatment patterns and outcomes of follow-up. We further compared these mixed adenomas with age- and sex-matched cases of GH mono-secreting PAs (GHPAs). The data of the included subjects were collected using electronic records from the hospital’s information system.ResultsBased on the inclusion and exclusion criteria, 21 GH/TSH cosecreting PAs were included. The average age of symptom onset was 41.6 ± 14.9 years old, and delayed diagnosis occurred in 57.1% (12/21) of patients. Thyrotoxicosis was the most common complaint (10/21, 47.6%). The median inhibition rates of GH and TSH in octreotide suppression tests were 79.1% [68.8%, 82.0%] and 94.7% [88.2%, 97.0%], respectively. All these mixed PAs were macroadenomas, and 23.8% (5/21) of them were giant adenomas. Comprehensive treatment strategies comprised of two or more therapy methods were applied in 66.7% (14/21) of patients. Complete remission of both GH and TSH was accomplished in one-third of cases. In the comparison with the matched GHPA subjects, the mixed GH/TSH group presented with a higher maximum diameter of the tumor (24.0 [15.0, 36.0] mm vs. 14.7 [10.8, 23.0] mm, P = 0.005), a greater incidence of cavernous sinus invasion (57.1% vs. 23.8%, P = 0.009) and a greater difficulty of long-term remission (28.6% vs. 71.4%, P <0.001). In addition, higher occurrence rates of arrhythmia (28.6% vs. 2.4%, P = 0.004), heart enlargement (33.3% vs. 4.8%, P = 0.005) and osteopenia/osteoporosis (33.3% vs. 2.4%, P = 0.001) were observed in the mixed PA group.ConclusionThere are great challenges in the treatment and management of GH/TSH cosecreting PA. Early diagnosis, multidisciplinary therapy and careful follow-up are required to improve the prognosis of this bihormonal PA.

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Section: Discussionsupporting

confidence: 93%

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center

Duan

et al. 2023

Front. Endocrinol.

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“…NFPAs are complex in their presentation and management outcomes in our region, and more NFPAs were observed in males with a mean age of 48 years at initial clinical presentation. Our data regarding gender and age distribution at the time of initial presentation are consistent with a recent study in an Irani population [10]. Most of our study participants presented with visual field defects (77%) and headache (55%), consistent with most of the published series to date [11].…”

Section: Discussionsupporting

confidence: 91%

Presentation, Management, and Outcomes of Nonfunctioning Pituitary Adenomas: An Experience from a Developing Country

Das¹,

Batool²,

Khoja³

et al. 2019

Cureus

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“…In our study, sex was identified to be a significant factor in subgroup analysis. Females (82.69%) were prone to develop meningiomas, and females accounted for 40% of NFPMA cases, which was similar to the results reported in previous studies (8,22,23). The clinical manifestations of both tumors were similar, mainly showing reduced vision, blurred vision, headache, and dizziness.…”

Section: Discussionsupporting

confidence: 88%

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

Zhang

Zhao

Dong

et al. 2020

Endocrine Connections

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Introduction and aim: It is difficult to distinguish between non-functioning pituitary macroadenomas (NFPMAs) and sellar meningiomas because of their overlapping imaging manifestations on routine magnetic resonance imaging (MRI), especially in cases of meningiomas growing into the saddle. Here, we aimed to differentiate between these two tumors using apparent diffusion coefficient (ADC) values and MRI characteristics. Methods: A total of 60 NFPMA and 52 sellar meningioma cases confirmed by pathological analysis were retrospectively reviewed. All patients were examined via routine MRI and diffusion weighted imaging (DWI) before undergoing surgery. The clinical, MRI characteristics, and max ADC (ADCmax), average ADC (ADCmean), and minimum ADC (ADCmin) values were compared between the two tumors via Chi-square test and two sample t-tests. Receiver operating characteristic (ROC) curve and binary logistic regression analyses were conducted to determine the discrimination ability. Results: The ADCmax, ADCmean, and ADCmin values were significantly higher in NFPMAs compared to sellar meningiomas (p < 0.001 for all). Among ADC values, ADCmax demonstrated good performance with an AUC of 0.896 (95% CI, 0.823-0.969) and accuracy of 88.7%. A cut-off value of 0.97 × 10−3 mm2/s was used for ADCmax for differentiation between tumors. A combination of ADCmax values and clinicoradiological features showed the best discrimination ability for differential diagnosis between the two tumors, with an AUC of 0.981 (95% CI, 0.958-1.000) and accuracy of 96.9%. Conclusion: A combination of ADCmax and clinicoradiological features demonstrates good discrimination ability and high accuracy for differentiation between NFPMAs and sellar meningiomas, and is a potential quantitative tool to aid in the selection of surgical techniques.

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Non-functioning pituitary macroadenoma: surgical outcomes, tumor regrowth, and alterations in pituitary function—3-year experience from the Iranian Pituitary Tumor Registry

Cited by 6 publications

References 36 publications

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center

Presentation, Management, and Outcomes of Nonfunctioning Pituitary Adenomas: An Experience from a Developing Country

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

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