Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Abstract

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.

Is positive staining of nonfunctioning pituitary adenomas for luteinizing hormone associated with poor prognosis?

“…A retrospective analysis of 142 patients who underwent surgery due to a NFPA showed that cavernous sinus invasion, lack of radiotherapy immediately after initial pituitary surgery, and positive immunostaining for hormones other than gonadotropins were risk factors for tumor recurrence (4). Moreover, postoperative recurrence rates were found to be significantly lower in patients who were asymptomatic than symptomatic at diagnosis of an incidentally detected NFPA (13). Furthermore, the risk of tumor recurrence was higher in patients with residual tumor and in those who did not receive radiotherapy (13,14).…”

“…Moreover, postoperative recurrence rates were found to be significantly lower in patients who were asymptomatic than symptomatic at diagnosis of an incidentally detected NFPA (13). Furthermore, the risk of tumor recurrence was higher in patients with residual tumor and in those who did not receive radiotherapy (13,14). A meta-analysis also showed that lack of radiotherapy after initial pituitary surgery was associated with an increased risk of tumor recurrence surgery (18).…”

Targeting PI3K/mTOR Signaling Displays Potent Antitumor Efficacy against Nonfunctioning Pituitary Adenomas

“…At this stage, more than 40% of NFPAs are invasive (3), so that complete surgical removal cannot be achieved. Reported recurrence rate varies between series, with up to 50% of patients experiencing long-term relapse (4,5). Management of patients with symptomatic residual and recurrent disease is challenging because no medical therapies are currently available.…”

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

“…An early diagnosis is obtained in the case of female patients [5] as reported by Nabarro [6]. The non-functioning pituitary adenomas are a heterogeneous subset of neoplasms of monoclonal origin of the adenohypophysis [7], which constitute 25-30% of pituitary neoplasias [8,9]. Diagnosis is usually established by detecting the predominant complications of neurological character, perhaps some degree of hypopituitarism, headache, and other clinical manifestations induced by the unpredictable biological behavior of those tumors.…”