The natural course of non-functioning pituitary macroadenomas

Abstract

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

Influence of GH substitution therapy in deficient adults on the recurrence rate of hormonally inactive pituitary adenomas: a case–control study

“…In consideration of these factors, our study provides further evidence that GH substitution therapy in GH-deficient adults with an underlying pituitary adenoma is felt a safe treatment. However, in slowly-growing benign tumours, even a follow-up of 5 years may not be adequate, especially since in non-functioning pituitary adenoma, the mean time to tumour growth/recurrence after initial therapy was found to be around 7 years (17,20). Thus, we agree with other investigators that longer follow-up periods are mandatory for a definite statement on the safety of GH treatment.…”

“…In the literature, the reported recurrence rate for hormonally inactive tumours varies tremendously, depending on the imaging method used and the duration of the follow-up period (17)(18)(19)(20). Depending on the centre, the extent of tumour resection and the follow-up period differed extremely between 8 and 71%.…”

Ocena efektów leczenia analogami somatostatyny nieczynnych hormonalnie gruczolaków przysadki w porównaniu z akromegalią

“…With reference to this goal, the use of somatostatin analogues appears to be somewhat controversial as they provide only stabilisation of tumour size in the overwhelming majority of cases (68% in our clinical study). However, stabilisation of tumour size is a remarkable achievement of the therapy, especially concerning the natural history of NFPA, which shows that these tumours regrow and must be reoperated in about 50% of cases [17]. This is the second clinical study to evaluate the longterm efficacy of somatostatin analogues in the treatment of NFPA.…”

Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas

“…Similar results were observed by other authors 20 . However, this behavior is different from non-functioning tumors that are not selected for surgery, which in the majority (83%) of cases remain stable in size 9,20 .…”

“…Since these tumors have no specific clinical outcome resulting from hormonal hypersecretion, they are usually recognized late and present large lesions with complex surgical management 7,8 . Their main signs and symptoms result from compression of surrounding structures, such as optic chiasm, thus causing bitemporal hemianopsia and destruction of pituitary cells, which results in varying deficits of hormonal secretion 1,2,9 . The objective of this study was to present a sample of cases of non-functioning tumors that received surgical treatment at the University Hospital of Brasília.…”