Aggressive pituitary adenomas and pituitary carcinomas

Barbara Buchalska; Jacek Kunicki; Maria Maksymowicz

doi:10.1530/endoabs.110.P900

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Endocrine Abstracts (2025) 110 P900 | DOI: 10.1530/endoabs.110.P900

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Aggressive pituitary adenomas and pituitary carcinomas

Barbara Buchalska ¹ , Jacek Kunicki ¹ & Maria Maksymowicz ²

Author affiliations

¹Maria Skłodowska-Curie National Research Institute of Oncology, Department of Neurosurgery, Warsaw, Poland; ²Maria Skłodowska-Curie National Research Institute of Oncology, Department of Pathology, Warsaw, Poland

JOINT2612

Introduction: Aggressive pituitary tumors (APTs) are rare neoplasms defined as invasive and refractory to treatment, with early recurrences. Pituitary carcinomas (PCs) besides their aggressive behavior are diagnosed by the presence of metastases. However, the diagnostic criteria for APTs are not well-defined and there are several approaches for characterizing aggressiveness. The aim of this study is to find clinical features characteristic for patients with APTs and PCs.

Material and Methods: The study is a retrospective analysis of a series of 45 patients (14 women and 31 men) treated from the 2006 to 2024 by the endoscopic transsphenoidal surgeries for pituitary adenomas presenting aggressive clinical behavior. The mean age of the patients was 48.4 years (20-70 years), and the mean follow-up period was 10.4 years (0-18 years).

Results: In this group 3 patients were diagnosed with PCs (6.7%) and the rest with APTs (93.3%). Six patients died during follow-up period (13.3%). There were 91.1% macroadenomas, the tumors were invasive in 75.5% and functioning in 33.3% of the patients. The patients had 3.3 resections for APTs or PCs on average. The Knosp scale grade assessed preoperatively was III in 9 patients (20.0%), and IV in 8 patients (17.8%). Twenty-nine patients (64.4%) had radiotherapy, and 13 patients had pharmacotherapy (28.9%) as additional treatment methods. According to Lyon’s classification the most numerous groups were 2a (35.6%) and 2b (28.9%). The gross total resection was accomplished in 17 cases (37.8%), the subtotal resection was achieved in 20 patients (44.4%), and in 6 cases (13.3%) only the partial resection was possible. Postoperatively 68.2% of the patients showed varying improvement in visual field defects and visual acuity. Transient diabetes insipidus (DI) was observed in 1 patient (2.2%), epistaxis in 4 patients (8.8%), and 2 patients (4.4%) had a postoperative oculomotor nerve paresis.

Conclusion: Surgical treatment of APTs and PCs is safe and associated with a low complication rate. The patients are younger and have more resections than in usual pituitary adenomas.