Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth

Greenman, Yona; Ouaknine, G; Veshchev, Igor; Reider‐Groswasser, Irith; Segev, Yael; Stern, Naftali

doi:10.1046/j.1365-2265.2003.01784.x

Cited by 203 publications

(173 citation statements)

References 23 publications

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“…The prevalence of incidentally discovered NFPA ranged between 9 and 21% in other similar surgical series (23,24,25). The reasons to perform the initial neuroradiological examinations in our patients were similar to those described by other authors (3, 4, 7, 8, 9, 10).…”

Section: Discussionsupporting

confidence: 67%

“…Recurrence of NFPA after surgery is reported between 12 and 45% (2,23,26,27,28). This variability reflects different surgical expertise, different criteria to define recurrence, the length of follow-up, and the use of postoperative radiotherapy (28).…”

Section: Surgery For Pituitary Incidentalomasmentioning

confidence: 99%

“…This variability reflects different surgical expertise, different criteria to define recurrence, the length of follow-up, and the use of postoperative radiotherapy (28). Incomplete removal is strongly associated with recurrence of NFPA (2,23,27,29,30), while adjuvant radiotherapy is very effective in reducing the risk of tumor regrowth (2,30,31). Our results show that patients with asymptomatic NFPA have a lower risk of tumor recurrence (HR of 0.30) than that of patients with symptomatic NFPA that is independent of all other characteristics, including the presence of postoperative remnants and utilization of radiotherapy.…”

Section: Surgery For Pituitary Incidentalomasmentioning

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: Discussionsupporting

confidence: 67%

Section: Surgery For Pituitary Incidentalomasmentioning

confidence: 99%

Section: Surgery For Pituitary Incidentalomasmentioning

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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“…This is debatable since other studies report higher incidence due to different diagnostic criteria [21][22][23][24]. This difference may be explained by our lack of utilization of the hypothalamuspituitary unit stimulation tests.…”

Section: Discussioncontrasting

confidence: 43%

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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“…Some studies report, to a variable degree, an improvement in pituitary function (4,(7)(8)(9)(10)(11), whereas others could not demonstrate significant improvement in pituitary function, or even showed decreased pituitary function after transsphenoidal surgery (5,12,13). Transsphenoidal surgery leads to long-term tumor control in approximately 80% of patients (3,(14)(15)(16), and, in selected series, in even more than 90% of the patients (15,17).…”

Section: Introductionmentioning

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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Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth

Abstract: Our data may ease the selection of patients in whom radiation therapy is likely to be necessary for tumour control, and confirms that close postoperative follow-up is an adequate primary approach in low-risk patients.

Cited by 203 publications

References 23 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

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

The natural course of non-functioning pituitary macroadenomas

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