Non-functioning pituitary adenomas (NFAs) constitute 25-30% of all pituitary tumours. NFAs do not secrete hormones and patients present with clinical features due to mass effects of the tumour such as visual field defects or hypopituitarism. Surgery and radiotherapy (RT) have been considered standard therapy for patients with a non-functioning macroadenoma. However, since MRI scanning has become widely available fewer patients are routinely referred for RT following surgery.
To investigate the long term outcome of different treatments in patients with a non-functioning macroadenoma; conservative management (6 monthly visual field tests and yearly MRI scanning), surgery or surgery + RT.
112 patients with a NFA were identified for this retrospective study from our Hospitals endocrine database.
Visual field defect was the commonest reason for clinical presentation. Tumour control was defined as the percentage of tumours that remained stable or decreased in size. Patients who were conservatively managed (n=38) had a tumour size of 14±1 mm and 76% of these patients had tumour control after 45±8 months follow-up. Patients undergoing surgery (n=43) had a tumour size of 28±2 mm and 75% had tumour control after 58±2 months follow-up. Patients in the surgery+RT group (n=31) had a tumour size of 27±2 mm and 84% had tumour control after 87±10 months follow-up. Pan-hypopituitarism was present in 13% of patients in the conservative group, 35% in the surgery group and 61% in the surgery+RT group.
Conservative management can be used in patients with NFAs without visual field defects. Surgery is appropriate for all patients who develop chiasmal compression and visual field defects. Surgery+RT have good tumour control over a long period of follow-up but are associated with increased pan-hypopituitarism which is associated with increased mortality.
06 - 07 Nov 2006
Society for Endocrinology