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

Yona Greenman; Naftali Stern


Clin Endocrinol. 2009;70(6):829-832. 

In This Article

Does Treatment Choice Affect Monitoring?

Patients in whom tumour has been completely excised usually undergo expectant follow-up as recurrence rates are low, as detailed earlier. In contrast, the optimal management of patients in whom residual tumour is detected on postoperative MRI is controversial, and may include observation alone,[6] the use of dopamine agonists (DA)[23] or radiation therapy.[24] Discussion on the merits or indications for the different therapeutic approaches is beyond the scope of this document. Nevertheless, the choice of treatment may influence some aspects of long-term monitoring. For example, particular attention should be given to pituitary function evaluation of irradiated patients in view of the high incidence of radiation-related hypopituitarism that is insidious and may take up to 20 years to develop.[24] Patients on DA therapy may need periodic echocardiograms in view of the increased incidence of valvular heart disease reported in cabergoline treated patients with Parkinson's disease,[25] although the lower doses used for treatment of pituitary disease have not generally been associated with clinically significant alterations in most studies.[26] Radiation and DA treatment reduce tumour progression rates to 8-20%[5] and 21%, respectively,[23] but because the anatomical response of an individual tumour to therapy cannot be anticipated, the imaging strategy should be similar to that of untreated patients.