Introduction: Non-functioning pituitary macroadenoma (NFMA) can cause considerable morbidity due to pituitary dysfunction and pressure effects. We present recent experience in managing cases diagnosed with NFMA at a single tertiary centre between January 2009 and October 2013.
Results: Of the 63 patients with NFMA, 28 (44%) were females. Age ranged from 22 to 91 (mean 63). Visual disturbance symptoms (35/63; 57%) were the commonest presentation. Headache was the next commonest (21/63; 33%), followed by hypogonadism (11/63; 17%), pituitary apoplexy (8/63; 13%), and cranial nerve palsies (5/63; 8%). Ten patients (16%) were diagnosed incidentally. Objective visual field defects were noted in 35 (57%). Prolactin levels ranged from 25 to 2536 mU/l (mean 394). Six patients (10%) were found hypothyroid at presentation. Pituitary MRI scan showed elevation or compression of optic chiasm in 55 patients (87%).
Forty-nine (78%) underwent endoscopic transsphenoidal hypophysectomy. The indications were large tumour abutting chiasm (19/49; 39%), visual field defects (10/49; 20%), loss of vision (8/49; 16%), headache (6/49; 12%), cranial nerve involvement (3/49; 6%), and further tumour enlargement (3/49; 6%). Post-operative complications included transient diabetes insipidus (5/49; 10%), CSF leak (2/29; 4%), and haemorrhage (1/49; 2%). 35 patients (71%) reported symptom improvement post-operatively. Post-operatively, hormone replacement was required with testosterone (19/49; 39%), thyroxine (15/49; 31%), hydrocortisone (14/49; 29%), and GH (1/49; 2%). Patients with apoplexy had emergency surgery (n=2), elective surgery (n=4), and conservative management (n=2). Five patients had improved vision following surgery, while one patient undergoing surgery after a year had no visual recovery.
Conclusion: NFMAs represent the bulk of patients undergoing pituitary surgery. The clinical presentation can vary widely from asymptomatic incidental finding to catastrophic pituitary apoplexy as seen in this series. Majority of NFMAs require surgery for different indications, although a select subset can be managed conservatively with long-term follow-up.