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Suprasellar pituitary adenomas: a 10-year experience in a single tertiary medical center and a literature review

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Abstract

Background

Suprasellar pituitary adenomas (SPAs) are a special type of pituitary adenoma. Although dozens of SPA cases have been reported, the exact definition and the characteristics of SPA have not been exhaustively discussed before.

Methods

In a retrospective electronic medical records review, 13 patients with SPA were identified in our hospital between January 2010 and December 2019. A literature review was performed by searching the online database PubMed, and 39 cases conformed to the criteria based on the previous literature. Data regarding clinical symptoms, imaging manifestations, surgical information and follow-ups were analyzed.

Results

The mean age at diagnosis of 52 patients with SPA was 36.73 years, and most of the patients were female (61.5%). The most common hormone-secreting subtypes of SPA were nonfunctioning (36.5%) and ACTH-secreting (34.6%) SPA. Macroadenomas (68.9%) were more common than microadenomas (31.1%). The origins of the SPAs included the intrasellar pituitary gland (type I), the subdiaphragmatic (type IIa) and supradiaphragmatic (type IIb) part of the pituitary stalk, and the suprasellar peri-infundibular region (type III). The most common anatomic subtype of SPA was type III, and type IIb was also common. The most common presentations of SPA were visual symptoms, especially for type III SPA. In addition, 64.7% and 73.1% of type IIb and III SPAs, respectively, were suspected to be of suprasellar origin based on presurgical imaging examination. Patients with tumors of suspected suprasellar origin were more likely to receive transcranial surgery (TCS) initially than those with tumors of suspected intrasellar origin (70.6% vs. 22.2%, p = 0.0013). The intact rate for the pituitary stalk after surgery for type II SPA was lower than that for type I and III SPA (52.6% vs. 92.6%, p = 0.0036). More patients with type II SPA experienced postoperative central diabetes insipidus (CDI) than those with type I and III SPA (57.9% vs. 11.1%, p = 0.0011). There was no significant difference in the incidence of postoperative CDI between transsphenoidal surgery (TSS) and TCS (p = 0.1304). Nine patients in our hospital received extended endoscopic TSS; only one experienced tumor recurrence, and no severe complications occurred after surgery.

Conclusions

SPAs could be defined as pituitary adenomas completely or partially located in the suprasellar region. There were both similarities and differences among the different anatomic subtypes of SPA. For patients who were suspected of having SPAs, visual field tests, pituitary hormone evaluation and MRI were necessary. Because imaging examination is not a reliable method, surgery is the only way to confirm the tumor origin. Extended endoscopic TSS might be a safe and efficient approach to remove these tumors, but more studies are needed to verify this conclusion. For type II SPA, the pituitary stalk should be carefully protected during surgery, and postoperative CDI should be monitored.

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Abbreviations

SPA:

Suprasellar pituitary adenoma

EPA:

Ectopic pituitary adenoma

ACTH:

Adrenocorticotrophic hormone

GH:

Growth hormone

TSH:

Thyroid stimulating hormone

PRL:

Prolactin

DS:

Diaphragma sellae

MRI:

Magnetic resonance imaging

CT:

Computed tomography

TCS:

Transcranial surgery

TSS:

Transsphenoidal surgery

UFC:

Urine free cortisol

DST:

Dexamethasone suppression test

IPSS:

Inferior petrosal sinus sampling

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Funding

This work was supported by the CAMS Innovation Fund for Medical Science (CAMS-2016-I2M-1-002).

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Author notes

  1. Jianyu Zhu, Zhicheng Wang and Yi Zhang contributed equally to this paper.

Authors and Affiliations

  1. Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China

    Jianyu Zhu, Zhicheng Wang, Yi Zhang, Jie Liu, Xiaoxu Li, Kan Deng & Yong Yao

  2. Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China

    Lin Lu

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  1. Jianyu Zhu
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  2. Zhicheng Wang
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Correspondence to Yong Yao.

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Zhu, J., Wang, Z., Zhang, Y. et al. Suprasellar pituitary adenomas: a 10-year experience in a single tertiary medical center and a literature review. Pituitary 23, 367–380 (2020). https://doi.org/10.1007/s11102-020-01043-1

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