Mortality in patients with non-functioning pituitary adenoma

Abstract

Non-functioning pituitary adenomas (NFA) are benign pituitary neoplasms not associated with clinical evidence of hormonal hypersecretion. A substantial number of patients with NFA have morbidities related to the tumor and possible recurrence(s), as well as to the treatments offered. Studies assessing the long-term mortality of patients with NFA are limited. Based on the published literature of the last two decades, overall, the standardized mortality ratios in this group suggest mortality higher than that of the general population with deaths attributed mainly to circulatory, respiratory and infectious causes. Women seem to have higher mortality ratios, and assessment of time trends suggests improvement over the years. There is no consensus on predictive factors of mortality but those most consistently identified are older age at diagnosis and high doses of glucocorticoid substitution therapy. Well designed and of adequate power studies are needed to establish the significance of factors compromising the survival of patients with NFA and to facilitate improvements in long-term prognosis.

Death from Neglected Pituitary Adenoma: A Case Report

“…It is very likely that the pituitary adenoma had been for a while inducing symptoms which were not heeded to until it became too late. Adenomas that grow very large tend to be the non-functional types [6,28] in most cases, although one series in the United States reported 5 giant prolactinomas in [7]. Patients with the functional adenomas normally seek medical attention quicker because of the endocrine symptoms they induce [16].…”

“…Mortality in the NFA adenoma is commonly due to hormone deficiency, surgery, and mass effect as they often grow very large before detection [28,29]. In one series patient died of circulatory complications, respiratory complications as well as infections [28], and in another series patients suffered occult hydrocephalus, and they died of complications following repeated interventions [30]. The common presentation of NFA remain, headaches visual disturbance and the hormonal deficiencies [31].…”

“…The common presentation of NFA remain, headaches visual disturbance and the hormonal deficiencies [31]. Among the functional adenomas (FA),mortality from vascular disease is the predominant cause of death [28]. In ACTH producing adenomas, control of cortisol and growth hormone secretion limits the cardiovascular risk [28].…”

“…Among the functional adenomas (FA),mortality from vascular disease is the predominant cause of death [28]. In ACTH producing adenomas, control of cortisol and growth hormone secretion limits the cardiovascular risk [28]. Pituitary apoplexy is a sudden vascular event in a PA that can also be life threatening [32,33], and has been reported to induce severe intracerebral haemorrhage [34,35], and death [36].…”

The Role of Single-Nucleotide Polymorphisms in Pituitary Adenomas Tumorigenesis

“…Nonfunctional PAs (NFPAs) are a common subtype of PA, accounting for roughly 25% of all PAs, but are not associated with hormonal hypersecretion [24,25]. Progression-free survival and recurrence rates are favorable amongst these tumors [24,26]. Arising from adenohypophyseal cells, these masses present either incidentally on imaging or via symptoms secondary to cranial mass such as headache, pituitary dysfunction, or visual disturbances.…”