Endocrine Abstracts

Introduction: Nonfunctioning pituitary adenomas (NFPAs) are a heterogeneous group of tumors with different presentations. Clinical management of these tumors is complex. Our aim was to evaluate the clinical characteristics/postsurgical outcomes of NFPAs and to identify predictive factors of good response to surgery.

Methods: Retrospective analysis of NFPA, who underwent surgery and followed in our hospital, from 2015-2022.

Results: We evaluated 15 patients (60%-male), whose median age at NFPA diagnosis was 59 (45-86) years. Adenomas were incidentally identified in 2 patients. Visual disturbances were the most common presenting symptom (67.7%). 47% of patients had ≧1 pituitary deficits and 1 patient had panhypopituitarism. Gonadotropic axis was the most commonly affected (60%). At diagnosis, hyperprolactinemia was present in 20% of cases. Preoperative ophthalmologic evaluation showed a visual field deficit in 64% and a significant decrease in visual acuity in 40% of the patients. Preoperative MRI studies displayed adenoma diameter of 29±16.2mm. Cavernous sinus (CS) was invaded in 47% of the patients and proximity/compression to the optic nerve/chiasm was present in 14 patients. Fourteen of these tumors were categorized as gonadotroph adenomas and 1 as silent corticotroph adenoma (SCA). 33% of the patients showed Ki67 values >3%. Patients with preoperative hypopituitarism, 4/7 (57%) showed improvement of pituitary function (PF) at one year. Improvement of neuro-ophthalmological symptoms was observed in all patients after surgery. Complete removal of the tumor was observed in 5 (33%) patients. Residual tumor (RT) was documented in 7 (47%) patients after first intervention. Three patients required a second surgery due to tumor regrowth, a median of 81 (60-276) months after first intervention. A fourth pituitary operation was performed in 1 patient. Stereotactic radiosurgery with gamma knife was used in one patient due to tumor progression (single case of SCA). Hyperprolactinemia at diagnosis tended to be more frequent in the group that recovered PF (P=0.091). RT after surgery tended to be more frequent in the group with larger tumors (P=0.043), older age (P=0.056) and CS invasion at diagnosis (P=0.067).

Conclusions: Patients with preoperative neuro-ophthalmological disturbances seem to benefit from surgery. In patients with tumors in progression and hypopituitarism, normalization of PF may be achieved with surgery. Hyperprolactinaemia and younger age at diagnosis, as well as tumor dimensions seem to be associated with a favorable prognosis. Our results highlight the need for a longstanding approach by a multidisciplinary team.