Incidentally found nonfunctioning pituitary macroadenomas: should we suspect them earlier?
Leonor Gomes1, Isabel Paiva1, Cristina Ribeiro1, Jacinta Santos1, Alexandra Vieira1, Mariana Martinho2, Márcia Alves1, Sofia Gouveia1, Manuel Rito3, Francisco Belo3, Olinda Rebelo4 & Manuela Carvalheiro1
Background: Nonfunctioning pituitary adenomas are commonly diagnosed as large tumors. Most are detected incidentally during imaging studies. The aim of this study was to evaluate clinical presentation, characteristics and outcome of nonfunctioning pituitary macroadenomas incidentally (NFPMI) discovered.
Methods: Twenty-seven patients (mean age 58.9 years, 4582; 18 males:9 females) with NFPMI were studied. They represent 13.1% of NFPM followed in our department. The reasons for neuroradiological studies were head trauma in 4 (14.8%); cerebral attacks in 12 (44.4%); sinusitis in 4 (14.8%); lipothymia/syncope in 3 (11.1%); hypoacusia 2 (7.4%) and cancer staging in 2 (7.4%).
Results: Of 62.9% had symptoms related with macroadenomas: vision alterations in 4 (14.8%); headache, dizziness, confusion, memory loss in 13 (48.1%); sexual dysfunction in 4 (14.8%) and amenorrhea in 2 (7.4%). Endocrinological evaluation showed global anterior hypopituitarism in one (14.2%) and partial hypopituitarism in 72.7%. Visual deficits were present in 15 (71.4%) patients. At MRI there was suprasselar extension in all cases, parasellar in 8 (29.6%) and infrasellar in 9 (33.3%). Mean diameter was 25.3 mm (1549.7 mm). Surgery was performed in all but four patients and two underwent also radiotherapy. Immunohistochemistry showed eighteen nonsecreting adenomas, two FSH, one ACTH, one TSH and two inconclusive. Surgery was highly effective in improving vision alterations (62.5%) but was enable to restore normal pituitary function in most cases. Five patients were lost for followed-up. At last MRI (mean follow-up 4.5 years, 6 months17 years) 6 (27.2%) patients were free of disease, 15 (68.1%) had remnants and one is waiting surgery.
Conclusions: NFPMI were very frequent among NFPM. Symptoms related to the macroadenomas were often overlooked. Hypopituitarism (86.9%) and vision alterations (71.4%) were high and only the last one recovered with surgery. It is important to be aware of the neurological and endocrinological symptoms in order to perform earlier diagnosis. This can avoid exposing patients to the risks of unrecognized hypopituitarism, permanent visual deficits and jeopardizing post-surgical outcome.