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Giant Non-Functioning Pituitary Adenoma: Clinical Characteristics and Therapeutic Outcomes.
- Source :
-
Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association [Exp Clin Endocrinol Diabetes] 2021 Mar; Vol. 129 (4), pp. 309-313. Date of Electronic Publication: 2020 Jan 02. - Publication Year :
- 2021
-
Abstract
- Background: Giant pituitary adenoma (≥4 cm) is a rare tumor whose clinical features and prognosis are not well known.<br />Aim: To evaluate the clinical characteristics and therapeutic outcomes of giant non-functioning PA (gNFPA).<br />Patients and Methods: A retrospective multicenter study of gNFPA patients diagnosed in a 12-year period was performed. In each patient, clinical data and therapeutic outcomes were registered.<br />Results: Forty patients (24 men, age 54.2 ± 16.2 years) were studied. The maximum tumor diameter [median (interquartile range)] was 4.6 cm (4.1-5.1). Women had larger tumors [4.8 cm (4.2-5.4) vs. 4.5 cm (4.0-4.9); p=0.048]. Hypopituitarism [partial (n=22, 55%) or complete (n=9, 22.5%)] at diagnosis was present in 77.5% of the patients. Visual field defects were found in 90.9%. The most used surgical technique was endoscopic endonasal transsphenoidal (EET) surgery (n=31, 77.5%). Radiotherapy was used in 11 (27.5%) patients (median dose 50.4 Gy, range 50-54). Thirty-seven patients were followed for 36 months (10-67 months). Although more than half of these patients showed tumor persistence (n=25, 67.6%), tumor size was significantly reduced [0.8 cm (0-2.5); p<0.001]. At last visit, 12 patients (32.4%) showed absence of tumor on MRI. Hypopituitarism rate was similar (75.0%), although with significant changes (p<0.001) in the distribution of the type of hypopituitarism. The absence of tumor at the last visit was positively associated with positive immunohistochemical staining for FSH (p=0.01) and LH (p=0.006) and negatively with female sex (p=0.011), cavernous sinus invasion (p=0.005) and the presence of Knosp grade 4 (p=0.013).<br />Conclusion: gNFPAs are more frequent in men but tumors are larger in women. Surgical treatment is followed by a complete tumor resection rate of approximately 30%. Positive immunostaining for gonadotropins is associated with tumor absence at last revision, while female sex and invasion of the cavernous sinuses with tumor persistence.<br />Competing Interests: Authors declare that they have no conflict of interest.<br /> (Thieme. All rights reserved.)
- Subjects :
- Adult
Aged
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neurosurgical Procedures
Pituitary Neoplasms complications
Pituitary Neoplasms pathology
Retrospective Studies
Adenoma complications
Adenoma pathology
Adenoma surgery
Hypopituitarism etiology
Hypopituitarism metabolism
Hypopituitarism surgery
Outcome Assessment, Health Care
Pituitary Neoplasms surgery
Vision Disorders etiology
Vision Disorders physiopathology
Vision Disorders therapy
Visual Fields physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1439-3646
- Volume :
- 129
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association
- Publication Type :
- Academic Journal
- Accession number :
- 31896156
- Full Text :
- https://doi.org/10.1055/a-1017-3288