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Retrospective observational analysis of non-irradiated non-functioning pituitary adenomas

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Abstract

Purpose

The management of choice of non-functioning pituitary adenomas (NFPAs) remains debulking surgery when symptomatic. However, patient series systematically reporting the NFPAs outcome that were not treated either surgically, medically or with radiotherapy during long follow-up thereby giving an indication of their natural history are limited. Aim of the present study was to evaluate the natural course of presumed NFPAs, the outcome of confirmed NFPAs during a long follow-up period.

Methods

Between 1993 and 2013, 84 patients with presumed NFPA were studied retrospectively. Patients were enrolled based on the following criteria: imaging suggestive of pituitary adenoma, absence of any biochemical/clinical evidence of hormonal excess, exclusion of prolactinomas and at least one sequential imaging during the follow-up. Repeated assessment of the pituitary function, visual fields and imaging was performed at regular intervals. The follow-up duration was evaluated from the first and last imaging dates.

Results

In group F (follow-up without surgery, 33 patients), the macroadenomas showed a 15 % probability of tumor growth and reduction. Similar tumor size alterations were observed also for the microadenomas. In group S (surgery, 51 patients), both residual tumors (>1 and <1 cm) following initial surgical resection remain mainly stable until the last imaging.

Conclusions

Based on the given lack of approved medical treatment and the possible risks of surgical intervention in presence of significant comorbidities, our study proposes a conservative approach with a careful follow-up in patients with NFPAs without visual or neurological abnormalities.

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References

  1. Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM (2001) Association between premature mortality and hypopituitarism. Lancet 357:425–431

    Article  CAS  PubMed  Google Scholar 

  2. van der Klaauw AA, Kars M, Biermasz NR, Roelfsema F, Dekkers OM, Corssmit EP, van Aken MO, Havekes B, Pereira AM, Pijl H, Smit JW, Romijn JA (2008) Disease specific impairments in quality of life during long-term follow-up of patients with different pituitary adenomas. Clin Endocrinol 69:775–784

    Article  Google Scholar 

  3. Greenman Y, Stern N (2009) Non-functioning pituitary adenomas. Best Pract Res Clin Endocrinol Metab 23:625–638

    Article  CAS  PubMed  Google Scholar 

  4. Davis JR, Farrell WE, Clayton RN (2001) Pituitary tumors. Reproduction 121:363–371

    Article  CAS  PubMed  Google Scholar 

  5. Buurman H, Saeger W (2006) Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. Eur J Endocrinol 154:753–758

    Article  CAS  PubMed  Google Scholar 

  6. Saeger W, Lüdecke 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 

  7. Yamada S, Ohyama K, Taguchi M, Takeshita A, Morita K, Takano K, Sano T (2007) A study of the correlation between morphological findings and biological activities in clinically nonfunctioning pituitary adenomas. Neurosurgery 61:580–585

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  10. Kanner AA, Corn BW, Greenman Y (2009) Radiotherapy of nonfunctioning and gonadotroph adenomas. Pituitary 12:15–22

    Article  PubMed  Google Scholar 

  11. Minniti G, Jaffrain-Rea ML, Osti M, Cantore G, Enrici RM (2007) Radiotherapy for nonfunctioning pituitary adenomas: from conventional to modern stereotactic radiation techniques. Neurosurg Rev 30:167–175

    Article  PubMed  Google Scholar 

  12. Andersen M, Bjerre P, Schrøder HD, Edal A, Høilund-Carlsen PF, Pedersen PH, Hagen C (2007) In vivo secretory potential and the effect of combination therapy with octreotide and cabergoline in patients with clinically non-functioning pituitary adenomas. Clin Endocrinol 54:23–30

    Article  Google Scholar 

  13. Behan LA, O’Sullivan EP, Glynn N, Woods C, Crowley RK, Tun TT, Smith D, Thompson CJ, Agha A (2013) Serum prolactin concentration at presentation of non-functioning pituitary macroadenomas. J Endocrinol Invest 36:508–514

    CAS  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. Ohta S, Yokoyama T, Uemura K (1998) Therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”). Neurosurgery 43:1344–1350

    PubMed  Google Scholar 

  16. Feldkamp J, Santen R, Harms E, Aulich A, Mödder 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 

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

    Article  CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  20. Dekkers OM, Hammer S, de Keizer RJ, Roelfsema F, Schutte PJ, Smit JW, Romijn JA, Pereira AM (2007) The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol 156:217–224

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  22. Newton DR, Dillon WP, Norman D, Newton TH, Wilson CB (1989) Gd-DTPA-enhanced MR imaging of pituitary adenomas. Am J Neuroradiol 10:949–954

    CAS  PubMed  Google Scholar 

  23. Nieman LK, Biller BM, Findling JW, Newell-Price J, Savage MO, Stewart PM, Montori VM (2008) The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 93:1526–1540

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA (2011) Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:273–288

    Article  CAS  PubMed  Google Scholar 

  25. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML (2011) Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1587–1609

    Article  CAS  PubMed  Google Scholar 

  26. Arita K, Tominaga A, Sugiyama K, Eguchi K, Iida K, Sumida M, Migita K, Kurisu K (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 

  27. Messerer M, Dubourg J, Raverot G, Bervini D, Berhouma M, George I, Chacko AG, Perrin G, Levivier M, Daniel RT, Trouillas J, Jouanneau E (2013) Non-functioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic. Clin Neurol Neurosurg 115(12):2514–2520

    Article  PubMed  Google Scholar 

  28. Bradley KM, Adams CB, Potter CP, Wheeler DW, Anslow PJ, Burke CW (1994) An audit of selected patients with non-functioning pituitary adenoma treated by transsphenoidal surgery without irradiation. Clin Endocrinol 41:655–659

    Article  CAS  Google Scholar 

  29. 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 43:432–439

    Article  CAS  PubMed  Google Scholar 

  30. Scheithauer BW, Jaap AJ, Horvath E, Kovacs K, Lloyd RV, Meyer FB, Laws ER Jr, Young WF Jr (2000) Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 47:723–730

    CAS  PubMed  Google Scholar 

  31. Greenman Y, Ouaknine G, Veshchev I, Reider-Groswasser II, Segev Y, Stern N (2003) Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol 58:763–769

    Article  CAS  Google Scholar 

  32. Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA (1999) Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation—a follow-up study. Clin Endocrinol 51:281–284

    Article  CAS  Google Scholar 

  33. Tanaka Y, Hongo K, Tada T, Sakai K, Kakizawa Y, Kobayashi S (2003) Growth pattern and rate in residual nonfunctioning pituitary adenomas: correlations among tumor volume doubling time, patient age, and MIB-1 index. J Neurosurg 98:359–365

    Article  PubMed  Google Scholar 

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Acknowledgments

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Ospedale S. Giovanni Battista-Molinette, C.so Dogliotti 14, 10126, Turin, Italy

    I. Karamouzis, R. Berardelli, N. Prencipe, A. Berton, C. Bona, V. Gasco, M. Maccario, E. Ghigo & S. Grottoli

  2. Neuroscience Department, University of Turin, Turin, Italy

    G. Stura & M. Corsico

Authors
  1. I. Karamouzis
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  2. R. Berardelli
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  3. N. Prencipe
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  4. A. Berton
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  5. C. Bona
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  6. G. Stura
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  7. M. Corsico
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  8. V. Gasco
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  9. M. Maccario
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  10. E. Ghigo
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  11. S. Grottoli
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Correspondence to S. Grottoli.

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The authors declare that all the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that an informed consent was obtained from all individual participants included in the study.

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Karamouzis, I., Berardelli, R., Prencipe, N. et al. Retrospective observational analysis of non-irradiated non-functioning pituitary adenomas. J Endocrinol Invest 38, 1191–1197 (2015). https://doi.org/10.1007/s40618-015-0361-0

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  • DOI: https://doi.org/10.1007/s40618-015-0361-0

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