Pituitary

, Volume 9, Issue 4, pp 317–321

Clinically non-functioning pituitary adenoma

Article

Abstract

Non-functioning pituitary tumors are relatively common. A large number of these tumors are incidentally found pituitary microadenomas (<1 cm) and are usually of no clinical importance. Those tumors that require treatment are generally macroadenomas and come to medical attention because of mass effect and/or hypopituitarism. Visual field defects are present in roughly 70% of patients with non-functioning macroadenoma at the time of diagnosis and the majority of these patients have at least growth deficiency and hypogonadism. By immunocytochemistry, the large majority of these tumors are glycoprotein producing and less commonly they are non-functioning somatotroph, lactotroph or corticotoph adenomas. In contrast to the immunocytochemistry results, only a minority of these tumors actively secrete intact gonadotrophs or glycoprotein subunits. Therapy is directed at eliminating mass effect and correcting hypopituitarism. There are anecdotal reports of tumor shrinkage during therapy with either dopamine agonists or somatostatin agonists; however tumor response to medical treatment is not reliable. For most patients, transphenoidal resection of the tumor is the preferable primary treatment. Surgery improves visual defects in the majority of patients and a lesser number will recover pituitary function. In the past, pituitary radiation was commonly administered following pituitary surgery; however the need for routine radiation has recently been reevaluated. Although tumor recurrence at 10 years post surgery may be as high as 50%, few patients with recurrence will have clinical symptoms. Close follow-up with surveillance pituitary scans should be performed after surgery and radiation therapy reserved for patients having significant tumor recurrence.

Keywords

Pituitary Adenoma Hypopituitarism Gonadotroph Null cell Radiation therapy Surgery Guidelines 

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Reference

  1. 1.
    Aron DC, Howlett TA (2000) Pituitary incidentalomas. Endocrinol Metab Clin North Am 29:205–221PubMedCrossRefGoogle Scholar
  2. 2.
    Bevan JS, Webster J, Burke CW, Scanlon MF (1992) Dopamine agonists and pituitary tumor shrinkage. Endocr Rev 13:220–240PubMedCrossRefGoogle Scholar
  3. 3.
    Buurman H, Saeger W (2006) Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol 154:753–758PubMedCrossRefGoogle Scholar
  4. 4.
    Colao A, Cerbone G, Cappabianca P, Ferone D, Alfieri A, Di Salle F, Faggiano A, Merola B, de Divitiis E, Lombardi G (1998) Effect of surgery and radiotherapy on visual and endocrine function in nonfunctioning pituitary adenomas. J Endocrinol Invest 21:284–290PubMedGoogle Scholar
  5. 5.
    Daneshdoost L, Gennarelli TA, Bashey HM, Savino PJ, Sergott RC, Bosley TM, Snyder PJ (1993) Identification of gonadotroph adenomas in men with clinically nonfunctioning adenomas by the luteinizing hormone beta subunit response to thyrotropin-releasing hormone. J Clin Endocrinol Metab 77:1352–1355PubMedCrossRefGoogle Scholar
  6. 6.
    Dekkers OM, Pereira AM, Roelfsema F, Voormolen JH, Neelis KJ, Schroijen MA, Smit JW, Romijn JA (2006) Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 91:1796–1801PubMedCrossRefGoogle Scholar
  7. 7.
    Donovan LE, Corenblum B (1995) The natural history of the pituitary incidentaloma. Arch Intern Med 155:181–183PubMedCrossRefGoogle Scholar
  8. 8.
    Greenman Y, Ouaknine G, Veshchev I, Reider G II, Segev Y, Stern N (2003) Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 58:763–769CrossRefGoogle Scholar
  9. 9.
    Harris PE (1998) Biochemical markers for clinically non-functioning pituitary tumours. Clin Endocrinol (Oxf) 49:163–164CrossRefGoogle Scholar
  10. 10.
    Katznelson L, Klibanski A (1996) Endocrine-inactive, FSH, LH and α-subunit adenomas: clinical findings and endocrinology. In: Landolt AM, Vance ML, Reilly PL (eds). Pituitary adenomas. Churchill Livingstone, New York, pp 127–138Google Scholar
  11. 11.
    Lillehei KO, Kirschman DL, Kleinschmidt-DeMasters BK, Ridgway EC (1998) Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas. Neurosurgery 43:432–438 discussion 438–439PubMedCrossRefGoogle Scholar
  12. 12.
    Lohmann T, Trantakis C, Biesold M, Prothmann S, Guenzel S, Schober R, Paschke R (2001) Minor tumour shrinkage in nonfunctioning pituitary adenomas by long-term treatment with the dopamine agonist cabergoline. Pituitary 4:173–178PubMedCrossRefGoogle Scholar
  13. 13.
    Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M (2005) Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 56:1222–1233PubMedCrossRefGoogle Scholar
  14. 14.
    Park P, Chandler WF, Barkan AL, Orrego JJ, Cowan JA, Griffith KA, Tsien C (2004) The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery 55:100–106 discussion 106–107PubMedCrossRefGoogle Scholar
  15. 15.
    Shomali ME, Katznelson L (1999) Medical therapy for gonadotroph and thyrotroph tumors. Endocrinol Metab Clin North Am 28:223–240, viiiPubMedCrossRefGoogle Scholar
  16. 16.
    Snyder PJ (1985) Gonadotroph cell adenomas of the pituitary. Endocr Rev 6:552–563PubMedCrossRefGoogle Scholar
  17. 17.
    Webb SM, Rigla M, Wagner A, Oliver B, Bartumeus F (1999) Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab 84:3696–3700PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  1. 1.Division of Metabolism, Endocrinology and DiabetesThe University of MichiganMichiganUSA

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