Skip to main content

Advertisement

SpringerLink
Log in

Management of nonfunctioning pituitary adenomas (NFAs): observation

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

Clinically nonfunctioning pituitary adenomas (NFAs) range from those causing significant hypothalamic/pituitary dysfunction and visual field compromise due to their large size to those being completely asymptomatic. In the absence of hypersecretion, hypopituitarism or visual field defects, patients with NFAs may be followed by periodic surveillance using MRI to detect tumor enlargement. In some cases, endocrine tests are also needed during observation to discover new pituitary dysfunction. Enlargement of NFAs without treatment occurs in about 10% of microadenomas and 23% of macroadenomas. Growth of a pituitary incidentaloma, the development of visual field defects or the development of hypopituitarism are potential indications for surgery during follow up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Saeger W, Ludecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol 156:203–216

    Article  CAS  PubMed  Google Scholar 

  2. Molitch ME (2009) Pituitary tumours: pituitary incidentalomas. Best Pract Res Clin Endocrinol Metab 23:667–675

    Article  CAS  PubMed  Google Scholar 

  3. Chambers EF, Turski PA, LaMasters D, Newton TH (1982) Regions of low density in the contrast-enhanced pituitary gland: normal and pathologic processes. Radiology 144:109–113

    Article  CAS  PubMed  Google Scholar 

  4. Elster AD (1993) Modern imaging of the pituitary. Radiology 187:1–14

    Article  CAS  PubMed  Google Scholar 

  5. Freda PU, Wardlaw SL, Post KD (1996) Unusual causes of sellar/parasellar masses in a large transsphenoidal surgical series. J Clin Endocrinol Metab 81:3455–3459

    CAS  PubMed  Google Scholar 

  6. Naidich MJ, Russell EJ (1999) Current approaches to imaging of the sellar region and pituitary. Endocrinol Metab Clin North Am 28:45–79

    Article  CAS  PubMed  Google Scholar 

  7. Doraiswamy PM, Potts JM, Axelson DA, Husain MM, Lurie SN, Na C et al (1992) MR assessment of pituitary gland morphology in healthy volunteers: age- and gender-related differences. Am J Neuroradiol 13:1295–1299

    CAS  PubMed  Google Scholar 

  8. Chanson P, Daujat F, Young J, Bellucci A, Kujas M, Doyon D et al (2001) Normal pituitary hypertrophy as a frequent cause of pituitary incidentaloma: a follow-up study. J Clin Endocrinol Metab 86:3009–3015

    Article  CAS  PubMed  Google Scholar 

  9. Elster AD, Chen MY, Williams DW, 3rd, Key LL (1990) Pituitary gland: MR imaging of physiologic hypertrophy in adolescence. Radiology 174:681–685

    Article  CAS  PubMed  Google Scholar 

  10. Tsunoda A, Okuda O, Sato K (1997) MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. AJNR Am J Neuroradiol 18:551–554

    CAS  PubMed  Google Scholar 

  11. Esteves C, Neves C, Augusto L, Menezes J, Pereira J, Bernardes I et al (2015) Pituitary incidentalomas: analysis of a neuroradiological cohort. Pituitary 18:777–781

    Article  CAS  PubMed  Google Scholar 

  12. Molitch ME (2012) Management of incidentally found nonfunctional pituitary tumors. Neurosurg Clin N Am 23:543–553

    Article  PubMed  Google Scholar 

  13. Molitch ME (2014) Nonfunctioning pituitary tumors. Handb Clin Neurol 124:167–184

    Article  PubMed  Google Scholar 

  14. Reincke M, Allolio B, Saeger W, Menzel J, Winkelmann W (1990) The incidentaloma of the pituitary gland: is neurosurgery required? JAMA 263:2772–2776

    Article  CAS  PubMed  Google Scholar 

  15. Donovan LE, Corenblum B (1995) The natural history of the pituitary incidentaloma. Arch Intern Med 155:181–183

    Article  CAS  PubMed  Google Scholar 

  16. Nishizawa S, Ohta S, Yokoyama T, Uemura K (1998) Therapeutic strategy for incidentally found pituitary tumors (pituitary incidentalomas). Neurosurgery 43:1344–1348 (discussion 1348–1350)

    CAS  PubMed  Google Scholar 

  17. Feldkamp J, Santen R, Harms E, Aulich A, Modder U, Scherbaum WA (1999) Incidentally discovered pituitary lesions: high frequency of macroadenomas and hormone-secreting adenomas—results of a prospective study. Clin Endocrinol 51:109–113

    Article  CAS  Google Scholar 

  18. Igarashi T, Saeki N, Yamaura A (1999) Long-term magnetic resonance imaging follow-up of asymptomatic sellar tumors—their natural history, surgical indications. Neurol Med Chir 39:592–598 (discussion 598–599)

    Article  CAS  Google Scholar 

  19. Sanno N, Oyama K, Tahara S, Teramoto A, Kato Y (2003) A survey of pituitary incidentaloma in Japan. Eur J Endocrinol 149:123–127

    Article  CAS  PubMed  Google Scholar 

  20. Day PF, Guitelman M, Artese R, Fiszledjer L, Chervin A, Vitale NM et al (2004) Retrospective multicentric study of pituitary incidentalomas. Pituitary 7:145–148

    Article  PubMed  Google Scholar 

  21. Arita K, Tominaga A, Sugiyama K, Eguchi K, Iida K, Sumida M et al (2006) Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination. J Neurosurg 104:884–891

    Article  PubMed  Google Scholar 

  22. Dekkers OM, Hammer S, de Keizer RJ, Roelfsema F, Schutte PJ, Smit JW et al (2007) The natural course of nonfunctioning pituitary macroadenomas. Eur J Endocrinol 156:217–224

    Article  CAS  PubMed  Google Scholar 

  23. Karavitaki N, Collison K, Halliday J, Byrne JV, Price P, Cudlip S et al (2007) What is the natural history of nonoperated nonfunctioning pituitary adenomas? Clin Endocrinol 67:938–943

    Article  CAS  Google Scholar 

  24. Anagnostis P, Admidou F, Polyzos SA, Efstathiadou Z, Panagiotou A, Kita M (2011) Pituitary incidentalomas: a single-centre experience. Int J Clin Pract 65(2):172–177

  25. Aghakhani K, Kadivar M, Kazemi-Esfeh S, Zamani N, Moradi M, Sanaei-Zadeh H (2011) Prevalence of pituitary incidentaloma in the Iranian cadavers. Indian J Pathol Microbiol 54:692–694

    CAS  PubMed  Google Scholar 

  26. Lenders N, Ikeuchi S, Russell AW, Ho KK, Prins JB, Inder WJ (2015) Longitudinal evaluation of the natural history of conservatively managed nonfunctioning pituitary adenomas. Clin Endocrinol 84(2):222–228

    Article  Google Scholar 

  27. Iglesias P, Arcano K, Trivino V, Garcia-Sancho P, Diez JJ, Villabona C et al (2017) Prevalence, clinical features, and natural history of incidental clinically nonfunctioning pituitary adenomas. Horm Metab Res 49:654–659

    Article  CAS  PubMed  Google Scholar 

  28. Fernandez-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA et al (2011) Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 96:905–912

    Article  CAS  PubMed  Google Scholar 

  29. Honegger J, Zimmermann S, Psaras T, Petrick M, Mittelbronn M, Ernemann U et al (2008) Growth modelling of nonfunctioning pituitary adenomas in patients referred for surgery. Eur J Endocrinol 158:287–294

    Article  CAS  PubMed  Google Scholar 

  30. Galland F, Vantyghem MC, Cazabat L, Boulin A, Cotton F, Bonneville JF et al (2015) Management of nonfunctioning pituitary incidentaloma. Ann Endocrinol 76:191–200

    Article  Google Scholar 

  31. Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD et al (2011) Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:894–904

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Chanson P, Raverot G, Castinetti F, Cortet-Rudelli C, Galland F, Salenave S (2015) Management of clinically nonfunctioning pituitary adenoma. Ann Endocrinol 76:239–247

    Article  Google Scholar 

  33. Messerer M, Dubourg J, Raverot G, Bervini D, Berhouma M, George I et al (2013) Nonfunctioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic. Clin Neurol Neurosurg 115:2514–2520

    Article  PubMed  Google Scholar 

  34. Scangas GA, Laws ER Jr (2014) Pituitary incidentalomas. Pituitary 17:486–491

    Article  PubMed  Google Scholar 

  35. Orija IB, Weil RJ, Hamrahian AH (2012) Pituitary incidentaloma. Best Pract Res Clin Endocrinol Metab 26:47–68

    Article  PubMed  Google Scholar 

  36. Arafah BM (1986) Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 62:1173–1179

    Article  CAS  PubMed  Google Scholar 

  37. Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J (1991) The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer 68:860–866

    Article  CAS  PubMed  Google Scholar 

  38. Losa M, Mortini P, Barzaghi R, Ribotto P, Terreni MR, Marzoli SB et al (2008) Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence. J Neurosurg 108:525–532

    Article  PubMed  Google Scholar 

  39. Nomikos P, Ladar C, Fahlbusch R, Buchfelder M (2004) Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas—a study on 721 patients. Acta Neurochir 146:27–35

    Article  CAS  PubMed  Google Scholar 

  40. Gsponer J, De Tribolet N, Deruaz JP, Janzer R, Uske A, Mirimanoff RO et al (1999) Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine 78:236–269

    Article  CAS  PubMed  Google Scholar 

  41. Losa M, Donofrio CA, Barzaghi R, Mortini P (2013) Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients’ characteristics. Eur J Endocrinol 169:735–742

    Article  CAS  PubMed  Google Scholar 

  42. Ambrosi B, Barbetta L, Dall’Asta C, Libe R (2001) Metamorphosis of a nonfunctioning pituitary adenoma to Cushing’s disease. Pituitary 4:127–128

    Article  CAS  PubMed  Google Scholar 

  43. Vaughan NJ, Laroche CM, Goodman I, Davies MJ, Jenkins JS (1985) Pituitary Cushing’s disease arising from a previously non-functional corticotrophic chromophobe adenoma. Clin Endocrinol 22:147–153

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 530, Chicago, IL, 60611, USA

    Wenyu Huang & Mark E. Molitch

Authors
  1. Wenyu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark E. Molitch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark E. Molitch.

Ethics declarations

Disclosure

WH has received research support from Chiasma. MEM has received research support from NovoNordisk, Chiasma and Novartis and has served as a consultant to Chiasma and Novartis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, W., Molitch, M.E. Management of nonfunctioning pituitary adenomas (NFAs): observation. Pituitary 21, 162–167 (2018). https://doi.org/10.1007/s11102-017-0856-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-017-0856-0

Keywords

Search

Navigation