Nonfunctioning adenomas (NFA) are 30% of all pituitary adenomas. Transphenoidal surgery is the first line therapy, but recurrences are frequent (12% al 69%). NFA treatment and follow-up are controversial. Aim of our study was to evaluate the recurrence prevalence and the factors associated with tumor aggressiveness in patients with NFA. We studied 30 patients that underwent surgery: 14 patients (group A, 7F, 3.92±12.48 years) with and 16 patients (group B, 6F, 56.5±12.31 years) without recurrence, with a follow-up of 7±4.49 years. At baseline, signs frequently observed were visual field defects (90%), headache (33%) e reduced energy (27%). In our study recurrence prevalence was 47%, mostly within 48 months after surgery. Only one patient recurred 156 months after surgery. In group A and B, 29% and 37% patients had normal pituitary function, respectively. In group A PRL level was significantly increased (P<0.05) compared to group B. No significant difference in neuroradiologic imaging was observed between the two groups, but suprasellar extension and chiasmal compression were more frequent in group A, where we also observed cavernous sinus invasion. Tumor size was greater in group A compared to group B (P<0.05). In group A, LH immunostaining was more frequently observed (P<0.05), while group B showed a higher number of null-cell adenomas (P<0.05). In our study 6 patients were treated with radiotherapy after first surgery and 3 patients after second or third surgery, but recurrences were observed also in early radiotreated patients. In conclusion, in this study, we observed that tumor size, cavernous sinus invasion, suprasellar extension, chiasmal compression, and LH immunostaining are associated to a higher recurrence rate after surgery. Our data confirm that long term follow-up is necessary, mostly within the first 5 years after surgery.
25 - 29 Apr 2009
European Society of Endocrinology