How Should a Nonfunctioning Pituitary Macroadenoma be Monitored After Debulking Surgery?

Yona Greenman; Naftali Stern

Disclosures

Clin Endocrinol. 2009;70(6):829-832. 

In This Article

Summary and Introduction

Summary

Transsphenoidal surgery is the treatment of choice for nonfunctioning pituitary macroadenomas but is seldom curative. Tumour progression rates are high in patients with postoperative remnants. Therefore, long-term monitoring is necessary to detect tumour growth, which may be asymptomatic or manifest with visual field defects and/or pituitary dysfunction. In view of the generally slow-growing nature of these tumours, yearly magnetic resonance imaging, neuro-ophalmologic and pituitary function evaluation are appropriate during the first 3-5 years after surgery. If there is no evidence for tumour progression during this period, testing intervals may be extended thereafter.

Introduction

Most clinically nonfunctioning pituitary adenomas (NFPA) are of gonadotroph cell origin, but rarely manifest with clinical signs or symptoms related to gonadotropin excess. Headaches, visual field compromise and decrease in visual acuity, as well as hypopituitarism are the most common presenting features of NFPA, and are all induced by pressure of the tumour on surrounding structures. Therefore, tissue decompression is the main therapeutic goal in NFPA, being effectively achieved in most cases through transsphenoidal excision of the tumour. Nevertheless, these usually large and invasive tumours often cannot be completely resected. NFPA patients need long-term surveillance, although the best means and frequency of follow-up have not been clearly established. The monitoring strategy used in our institution and presented herein has evolved based on published observational studies on the natural history of NFPA, and clinical experience.

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