ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 S24.1

Nonfunctioning pituitary macroadenomas: treatment and follow-up

Olaf M Dekkers

Leiden University Medical Center, Leiden, The Netherlands.

Nonfunctioning pituitary macroadenomas are benign tumors, characterized by the clinical and biochemical absence of hormonal overproduction. Clinical symptoms are mainly caused by mass effects of the tumor. The main symptoms are pituitary insufficiencies, visual field defects, decreased visual acuity and headache. For nonfunctioning adenomas with a diameter of less than one cm no treatment is necessary. In patients with a nonfunctioning macroadenoma without visual field defects, the approach can be expectative in individual cases. Transsphenoidal surgery is indicated in patients with visual field defects. Improvement of visual field defects is achieved the majority of patients after surgery. This improvement continues until 1 year after surgery. In contrast to visual function, pituitary function is not likely to be restored after transsphenoidal surgery. Because the adenomas have the propensity for regrowth, after primary treatment life long follow-up is necessary. Until now, there is no reliable tumor-marker for nonfunctioning pituitary tumors. For that reason MRI is the method of choice during long-term follow-up. The assessment of visual field defects is a sensitive method for the detection of tumor growth only when the tumor is close to the chiasm. Because of the propensity of growth, sometimes postoperative prophylactic radiotherapy is advocated. However, even radiotherapy does not prevent tumor regrowth in all cases and adequate tumor control can be achieved by transsphenoidal surgery alone. A strategy without postoperative radiotherapy will prevent that a large number of patients will be exposed to the long-term sequelae of radiotherapy without having any benefit. In treated patients with a nonfunctioning pituitary adenoma, a decreased quality of life has been reported, probably due to the intrinsic imperfection of hormonal replacement therapy.

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