How are pituitary adenomas treated in patients with hypopituitarism (panhypopituitarism)?

Updated: Jun 09, 2020
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

A retrospective study by Graffeo et al indicated that in radiation-naïve patients receiving single-fraction stereotactic radiosurgery for pituitary adenoma, a mean gland dose of less than 11.0 Gy may reduce the likelihood of posttreatment hypopituitarism. The investigators found that in patients who received this lower dose, the rates of hypopituitarism at 2 and 5 years were 2% and 5%, respectively, compared with 31% and 51%, respectively, for those who received a mean dose of 11.0 Gy or higher. [22]

A study by Lee et al found that in patients with nonfunctioning pituitary adenomas, gross-total resection and/or adjuvant radiotherapy appear to prevent tumor recurrence or regrowth. The study involved 289 patients, 193 of whom had gross-total resection, 53 of whom had near-total resection, and 43 of whom had subtotal resection. [23]

A literature review by Li et al indicated that in the surgical treatment of pituitary adenomas, endoscopic transsphenoidal surgery is more successful than microscopic transsphenoidal surgery in gross tumor removal and, unlike the microscopic technique, does not significantly affect cerebrospinal fluid leak risk. Moreover, the endoscopic surgery significantly decreases septal perforation risk and is not linked to an increased risk for meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocortisolism, total mortality, or recurrence. [24]

In very ill hospitalized patients or in patients undergoing major procedures, stress-dose steroids are required and are quickly tapered to a maintenance schedule after the procedure. Minor procedures or illnesses may not necessitate a change in steroid dose or may require a simple doubling of the usual daily dose until the illness resolves. Other hormone replacements are continued at their usual maintenance doses as appropriate.

No special diet is necessary in patients with hypopituitarism unless dictated by an underlying disease process. Also, no activity restrictions are necessary unless dictated by an underlying disease process. Include an endocrinologist, a neurosurgeon, and a radiologist in consultations, as appropriate.

The World Health Organization's 2017 classification of pituitary tumors lists adenoma subtypes that may be more aggressive and likely to recur, requiring additional therapy. [25]


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