Retrospective observational analysis of non-irradiated non-functioning pituitary adenomas

Dho

Journal of Neurosurgery

et al. 2019

OBJECTIVE The natural history and proper algorithm for follow-up testing of nonfunctioning pituitary adenomas (PAs) are not well known, despite their relatively high prevalence. The aim of this study was to suggest the optimal follow-up algorithm for nonfunctioning PAs based on their natural history. METHODS The authors followed up 197 patients with nonfunctioning PAs that had not been treated (including surgery and radiation therapy) at the time of detection, in a single center, between March 2000 and February 2017. They conducted a hormone test, visual field test, and MRI at the time of diagnosis and yearly thereafter. RESULTS The overall median follow-up duration was 37 months. Microadenomas (n = 38) did not cause visual disturbance, pituitary apoplexy, or endocrine dysfunction. The incidence of patients with tumor volume growth ≥ 20% was higher for macroadenomas than microadenomas (13.8 vs 5.0 per 100 person-years [PYs], p = 0.002). The median time to any tumor growth was 4.8 years (95% CI 3.4-4.8 years) for microadenomas and 4 years (95% CI 3.3-4.2 years) for macroadenomas. The overall incidence of worsening visual function was 0.69 per 100 PYs. Patients with a tumor volume growth rate ≥ 0.88 cm/year (n = 20) had a higher incidence of worsening visual function (4.69 vs 0.30 per 100 PYs, p < 0.001). The tumor growth rate of all microadenomas was < 0.88 cm/year. The median time to tumor growth ≥ 20% was 3.3 years (95% CI 1.8-3.9 years) in patients with a tumor growth rate ≥ 0.88 cm/year and 4.9 years (95% CI 4.6-7.2 years) in patients with a tumor growth rate < 0.88 cm/year. CONCLUSIONS The authors have devised a follow-up strategy based on the tumor volume growth rate as well as initial tumor volume. In patients with microadenomas, the next MRI study can be performed at 3 years. In patients with macroadenomas, the second MRI study should be performed between 6 months and 1 year to assess the tumor growth rate. In patients with a tumor growth rate ≥ 0.88 cm/year, the MRI study should be performed within 2 years. In patients with a tumor growth rate < 0.88 cm/year, the MRI study can be delayed until 4 years.

mentioning

confidence: 99%

Developing an optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas

Dho

Journal of Neurosurgery

et al. 2019

“…We can assume that only a minority of nonfunctioning PAs exhibit considerable growth and become clinically relevant, while the majority remain stable or show extremely slow growth velocity [11]. Many previous studies have also proposed a conservative approach with careful follow-ups in patients with PAs without visual or neurological abnormalities [1,6,13,18]. So, the ‘wait-and-see’ policy might seem reasonable for PAs without symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Pituitary adenomas (PAs) are not usually associated with clinical syndromes related to hormone excess and may be discovered occasionally, when they are not hormonally active [13]. So, they usually escape early diagnosis and are mainly discovered when they exert mass effects on surrounding tissues leading to visual impairments, headache and hypopituitarism [9].…”

Section: Introductionmentioning

confidence: 99%

“…The option for treatment for patients with symptomatic PAs is debulking surgery, but, in the absence of mass effects, a “wait and see” approach with a serial evaluation of tumor growth and visual function could be a possible therapeutic choice [8]. However, patient series systematically reporting the PAs outcome that were not treated either surgically, medically, or with radiotherapy during long-term follow-ups are scarce [8,13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Growth Pattern and Prognostic Factors of Untreated Nonfunctioning Pituitary Adenomas

Hwang

Kwon

Park

et al. 2019

J Korean Neurosurg Soc

ObjectivePituitary adenomas (PAs) are often detected as incidental findings. However, the natural history remains unclear. The objective of this study was to evaluate the natural history and growth pattern of untreated PAs. MethodsBetween 2003 and 2014, 59 PAs were managed with clinico-radiological follow up for longer than 12 months without any kind of therapeutic intervention. Tumor volumes were calculated at initial and last follow-up visit, and tumor growth during the observation period was determined. Data were analyzed according to clinical and imaging characteristics. ResultsThe mean initial and last tumor volume and diameter were 1.83±2.97 mL and 13.77±6.45 mm, 2.85±4.47 mL and 15.75±8.08 mm, respectively. The mean annual tumor growth rate was 0.33±0.68 mL/year during a mean observation period of 46.8±32.1 months. Sixteen (27%) PAs showed tumor growth. The initial tumor size (HR, 1.140; 95% confidence interval, 1.003–1.295; p=0.045) was the independent predictive factor that determined the tumor growth. Six patients (11%) of 56 conservatively managed non-symptomatic PAs underwent resection for aggravating visual symptoms with mean interval of 34.5 months from diagnosis. By Cox regression analysis, PAs of last longest diameter over 21.75 mm were a significant prognostic factor for eventual treatment. ConclusionThe initial tumor size of PAs was independently associated with the tumor growth. Six patients (11%) of conservatively managed PAs were likely to be treated eventually. PAs of last follow-up longest diameter over 21.75 mm were a significant prognostic factor for treatment. Further studies with a large series are required to determine treatment strategy.

“…Because only 25% of the nonfunctioning macroadenomas increase in size significantly during follow-up[ 2 9 ] after the first surgery, we opted for clinical follow-up for this patient. Moreover, it is known that the extent of tumor removal has no impact at mortality in these patients.…”

Section: Discussionmentioning

confidence: 99%

Pituitary carcinoma: A case report and discussion of potential value of combined use of Ga-68 DOTATATE and F-18 FDG PET/CT scan to better choose therapy

Garmes¹,

Carvalheira²,

Reis³

et al. 2017

Surg Neurol Int

Background:Pituitary carcinoma is extremely rare and carries a very poor prognosis. In most cases, apparently indolent tumors become malignant; however, there are no satisfactory biomarkers for predicting tumor behavior. Thus, scientific advances in the search for new biological markers, diagnostic methods, and therapies are needed to improve the prognosis of these patients.Case Description:We report the case of a woman with initial diagnosis of nonfunctioning pituitary adenoma which evolved to carcinoma after 4 years. Diagnosis was confirmed after biopsy of metastatic pulmonary nodules, in which neoplastic cells were immunohistochemically positive for chromogranin, synaptotophysin, prolactin, and growth hormone. Investigation with conventional somatostatin receptor scintigraphy, positron emission tomography-computed tomography (PET-CT) with Ga-68 DOTATATE and F-18 fluorodeoxyglucose (FDG) are showed. During temozolomide therapy, our patient had severe pancytopenia resulting in death from generalized infection despite 10 days of intensive care.Conclusion:The present case of an aggressive pituitary carcinoma rising from a typical adenoma illustrates the importance of developing new prognostic biomarkers in these cases. In addition to demonstrating a serious side effect with the use of temozolomide, our case report suggests that the combined use of Ga-68 DOTATATE and F-18 FDG PET-CT scan may scale somatostatin receptors vs. tumor aggressiveness, therefore, helping to better choose the therapy for aggressive pituitary tumors.