Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Primary Management of Patients With Nonfunctioning Pituitary Adenomas

Lucas, Joshua; Bodach, Mary E.; Tumialán, Luis M.; Oyesiku, Nelson M.; Patil, Chirag G.; Litvack, Zachary; Aghi, Manish K.; Zada, Gabriel

doi:10.1227/neu.0000000000001389

Cited by 91 publications

(57 citation statements)

References 23 publications

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“…Based on the available clinical evidence, mainly retrospective and prospective observational cohort studies, pituitary surgery is the treatment of choice in symptomatic CNFPA patients and in those who show tumor growth during follow-up. Surgery is accompanied by a significant reduction in tumor size, and a significant improvement in both visual and pituitary functions [23]. It is note-worthy that in our series of incidental CNFPAs, a high percentage (42.1 %) was treated with surgery suggesting a high prevalence of non-perceived symptoms (neuroophtalmologic and/or endocrine symptoms) in these patients.…”

Section: Discussionmentioning

confidence: 63%

Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas

et al. 2017

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The objective of the study was to assess the prevalence and clinical features of incidentally discovered clinically non-functioning pituitary adenoma (CNFPA) and to analyze its natural history. A multicenter retrospective study in patients diagnosed with incidental CNFPA periodically followed-up in 3 specialized neuroendocrinology units from 1992 to 2015 was performed. Out of a total of 189 CNFPA patients, 57 cases (30.1%; 29 women; age at diagnosis 55.8±16.7 years) were incidental. Most patients (n=55, 96.5%) were diagnosed by magnetic resonance imaging (MRI). A sum of 71.9% (n=41) were macroadenomas; 2 of them (3.5%) were giant adenomas (≥4 cm). Patients with macroadenomas were older than those with microadenomas (59.5±16.7 vs. 46.4±18.1 years, p=0.007). Macroadenomas were more common in men (85.7% vs. 58.6%, p=0.023). Twenty-eight patients (49.1%) showed suprasellar extension; of these, 19 were accompanied by chiasmatic compression. Hypopituitarism was present in 14 (24.6%) patients; which was partial in 13 patients (22.8%) and complete in one patient (1.8%). The gonadal axis was the most frequently affected (n=13, 22.8%). Twenty four patients (42.1%) underwent surgery. Of the non-operated patients, 26 patients could be evaluated morphologically after a median follow-up of 15.5 months (interquartile range, 5.7-32.7 months). No significant changes were found in the maximum tumor diameter at the end of follow-up (1.2±0.6 vs 1.2±0.7 cm). The majority of CNFPAs evaluated (n=23, 88.5%) did not show any changes in size. In 2 cases (7.7%) tumor size decreased, and in one patient (3.8%) increased. In our series of CNFPA patients, approximately one-third were incidental. These tumors were diagnosed by MRI preferably from the 5th decade of life without sex predilection. Most of them were macroadenomas, more commonly diagnosed in men and at an older age, compared to microadenomas. The suprasellar extension with chiasmatic compression and hypopituitarism were frequent at diagnosis. Most of the non-operated incidental CNFPAs remain with stable tumor size over time, growth being an unusual event.

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Section: Discussionmentioning

confidence: 63%

Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas

et al. 2017

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“…5 Nonfunctioning adenomas are those without any recognizable hormone production and may present clinically with vision loss or hypopituitarism. 6 A broad spectrum of visual symptoms has been reported in the literature, ranging from no alteration to blindness. 7 Visual impairment may comprise a decrease in visual acuity (41%), impaired color vision (56-71%), ocular movement alterations (8%), and visual field disturbances, the last one being the most common, with a reported prevalence from 37 to 96% in different studies.…”

Section: Introductionmentioning

confidence: 99%

Visual Outcomes after Endoscopic Pituitary Surgery in Patients Presenting with Preoperative Visual Deficits

et al. 2017

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Pituitary adenomas represent 15% of primary brain tumors. Visual disturbance is a common clinical manifestation of these neoplasms due, among other factors, to local mass effect on the optic system. To evaluate changes of the visual fields in patients undergoing endoscopic endonasal approach (EEA) for pituitary adenomas and to find predictive factors for successful visual field outcome. This is a cross-sectional study. A review was conducted of medical records of consecutive patients with tumors of the sellar region undergoing EEA between January 2008 and December 2012 at the Skull Base Unit of Guillermo Grant Benavente Hospital, University of Concepción, Concepción, Chile, and who had undergone pre- and postoperative visual field evaluation. A total of 35 patients, with a mean age of 50.2 years, fulfilled the inclusion criteria. All patients had objective visual field disturbances before the surgery. Following surgery, 25 patients (71.4%) had favorable outcomes, whereas 8 (22.8%) had no change and 2 (5.8%) had an unfavorable outcome. Complete tumor removal was associated with a better visual outcome than those obtained after a subtotal removal. The EEA for pituitary tumors is particularly effective for visual field disturbances, with reported improvement rates ranging from 50 to 90%. Our series show similar results, with a 71.4% improvement of visual field disturbances. This study adds further evidence to the current belief that EEA for pituitary adenomas is a safe and effective technique to improve visual field alterations. Complete removal of the tumor during surgery seems to be a predictive factor for a good visual outcome.

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“…Immediate tumour volume decrease was observed in nearly all patients with a residual tumour rate of 10-36% (Lucas et al 2016). Visual improvement is observed in 75-91% of patients, while 35-50% of patients display an improvement in hypopituitarism (Lucas et al 2016). It has been reported that a postoperative improvement in gonadal, thyroid and adrenal axes occurs in 64.9, 71.9 and 33.9% of cases, respectively (Nomikos et al 2004).…”

Section: Surgical Treatmentmentioning

confidence: 91%

“…TSS, when performed by an experienced surgeon, is a safe procedure with relatively low complication rates: a total resection is achieved in 60-73% of NFPitNETs (Yu et al 2018). Immediate tumour volume decrease was observed in nearly all patients with a residual tumour rate of 10-36% (Lucas et al 2016). Visual improvement is observed in 75-91% of patients, while 35-50% of patients display an improvement in hypopituitarism (Lucas et al 2016).…”

Section: Surgical Treatmentmentioning

confidence: 96%

The natural history and treatment of non-functioning pituitary adenomas (non-functioning PitNETs)

Yavropoulou

Tsoli

Barkas

et al. 2020

Endocrine-Related Cancer

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Non-functioning pituitary adenomas, recently alternatively-termed pituitary neuroendocrine tumours (NFpitNETs), are mostly benign neoplasms that are not associated with a hormonal hypersecretory syndrome. The clinical spectrum of NFpitNETs varies from completely asymptomatic to the development of panhypopituitarism and manifestations attributed to mass effects on nearby structures. NFpitNETs follow generally an indolent course, but in 5%-10% of cases they exhibit more aggressive behavior, characterised by rapid growth, invasiveness and early recurrence. The initial size of the adenoma, the presence of symptoms and the histological subtype are related to the natural course of NFpitNETs. Active surveillance is usually the strategy of choice in the case of an asymptomatic NFpitNET, while surgical resection is recommended in case of visual and/or neurological abnormalities or rapid tumour growth. Based on previous and emerging data, approximately 50% of patients show tumour growth while 20% of patients with NF-macroadenomas on active surveillance may require further intervention during a follow-up period of 7 years. Adjuvant radiotherapy is usually considered for large residual tumours or recurrent and/or aggressive adenomas, but there is evidence that medical therapy, especially with cabergoline, can occasionally be beneficial, whereas newer molecular agents are under investigation. Thus, while highly effective medical therapy is awaited, a move towards a more conservative approach seems appropriate, at least until we have better molecular markers of progressiveness.

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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Primary Management of Patients With Nonfunctioning Pituitary Adenomas

Abstract: NFPA, nonfunctioning pituitary adenoma.

Cited by 91 publications

References 23 publications

Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas

Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas

Visual Outcomes after Endoscopic Pituitary Surgery in Patients Presenting with Preoperative Visual Deficits

The natural history and treatment of non-functioning pituitary adenomas (non-functioning PitNETs)

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