Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pituitary Macroadenomas Follow-up

  • Author: James R Mulinda, MD, FACP; Chief Editor: George T Griffing, MD  more...
 
Updated: Jul 22, 2016
 

Further Outpatient Care

Monitor for remission by hormone assays and tumor size. Monitor for development of hypopituitarism. Radiation therapy may cause hypopituitarism months to years later.

Next

Further Inpatient Care

Correction of hormone imbalances should be attempted preoperatively. Adrenocortical insufficiency should be sought and corrected.

Transient diabetes insipidus is common following surgery for macroadenomas. A triphasic response where diabetes insipidus is followed by hyponatremia and, later, diabetes insipidus again is more frequent following surgery for macroadenomas than microadenomas. Vasopressin may be required transiently. Permanent diabetes insipidus, however, is not frequent.

Previous
Next

Inpatient & Outpatient Medications

Medications are based on hormonal abnormalities. For instance, dopaminergic agents are used for hyperprolactinemia, and somatostatin analogues are used for acromegaly.

Previous
Next

Complications

Complications result from mass effects and abnormal hormone function.[20]

Pituitary apoplexy, which is an acute hemorrhagic infarction of a pituitary tumor, requires emergency decompression. It presents with adrenal crisis and a severe headache followed by coma and death within hours if not appropriately managed.

Postoperatively, pituitary hormone insufficiency, including diabetes insipidus, hypothyroidism, and hypogonadism, may occur.

Radiation treatment exceeding 60 Gy can be associated with optic nerve neuropathy and brain necrosis.

Pituitary hormone insufficiency might present several years after treatment.

Other complications include visual impairment, obesity, and memory impairment.

Pregnancy is associated with hyperprolactinemia. Treatment for hyperprolactinemia should be withheld unless the sudden increase is suggestive of a marked increase in the size of the tumor. Pregnancy is also associated with lymphocytic hypophysitis, an autoimmune inflammatory lesion of the pituitary that often presents with adrenal insufficiency.

Previous
Next

Prognosis

Prognosis is variable depending on patient status, comorbid conditions, tumor size, and functional status of the tumor.

Small, nonfunctioning tumors that undergo curative surgical extirpation have an excellent prognosis compared to unresectable, giant macroadenomas.

Tumors that continue to secrete excess hormone despite aggressive treatment carry a poor prognosis. Such cases include Cushing disease and acromegaly.[21]

A meta-analysis showed that macroadenomas tend to enlarge more frequently (12.5 per 100 patient-years [95% CI 7.9 - 17.2] than microadenomas (3.3 per 100 patient-years [95% CI 2.1-4.5]).[22]

Previous
Next

Patient Education

Patient education and support groups include the Pituitary Network Association.

Previous
 
Contributor Information and Disclosures
Author

James R Mulinda, MD, FACP Consulting Staff, Department of Endocrinology, Endocrinology Associates, Inc

James R Mulinda, MD, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Yoram Shenker, MD Chief of Endocrinology Section, Veterans Affairs Medical Center of Madison; Interim Chief, Associate Professor, Department of Internal Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Wisconsin at Madison

Yoram Shenker, MD is a member of the following medical societies: American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Dimitris A Papanicolaou, MD 

Dimitris A Papanicolaou, MD is a member of the following medical societies: American College of Physicians, Endocrine Society, Royal Society of Medicine

Disclosure: Nothing to disclose.

References
  1. Chahal HS, Stals K, Unterlander M, et al. AIP mutation in pituitary adenomas in the 18th century and today. N Engl J Med. 2011 Jan 6. 364(1):43-50. [Medline].

  2. Alimohamadi M, Sanjari R, Mortazavi A, Shirani M, Moradi Tabriz H, Hadizadeh Kharazi H, et al. Predictive value of diffusion-weighted MRI for tumor consistency and resection rate of nonfunctional pituitary macroadenomas. Acta Neurochir (Wien). 2014 Dec. 156(12):2245-52. [Medline].

  3. Greenman Y, Stern N. How should a nonfunctioning pituitary macroadenoma be monitored after debulking surgery?. Clin Endocrinol (Oxf). 2009 Jun. 70(6):829-32. [Medline].

  4. Parhar PK, Duckworth T, Shah P, et al. Decreasing Temporal Lobe Dose with Five-Field Intensity-modulated Radiotherapy for Treatment of Pituitary Macroadenomas. Int J Radiat Oncol Biol Phys. 2009 Dec 14. [Medline].

  5. Loeffler JS, Shih HA. Radiation therapy in the management of pituitary adenomas. J Clin Endocrinol Metab. 2011 Jul. 96(7):1992-2003. [Medline].

  6. Marek J, Jezkova J, Hana V, et al. Is it possible to avoid hypopituitarism after irradiation of pituitary adenomas by the Leksell gamma knife?. Eur J Endocrinol. 2011 Feb. 164(2):169-78. [Medline].

  7. Wu JS, Shou XF, Yao CJ, et al. Transsphenoidal pituitary macroadenomas resection guided by PoleStar N20 low-field intraoperative magnetic resonance imaging: comparison with early postoperative high-field magnetic resonance imaging. Neurosurgery. 2009 Jul. 65(1):63-70; discussion 70-1. [Medline].

  8. Fomekong E, Maiter D, Grandin C, et al. Outcome of transsphenoidal surgery for Cushing's disease: a high remission rate in ACTH-secreting macroadenomas. Clin Neurol Neurosurg. 2009 Jun. 111(5):442-9. [Medline].

  9. Theodosopoulos PV, Leach J, Kerr RG, et al. Maximizing the extent of tumor resection during transsphenoidal surgery for pituitary macroadenomas: can endoscopy replace intraoperative magnetic resonance imaging?. J Neurosurg. 2009 Oct 16. [Medline].

  10. Pinar E, Yuceer N, Imre A, Guvenc G, Gundogan O. Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas. J Craniofac Surg. 2014 Dec 2. [Medline].

  11. Paek SH, Downes MB, Bednarz G, Keane WM, Werner-Wasik M, Curran WJ Jr, et al. Integration of surgery with fractionated stereotactic radiotherapy for treatment of nonfunctioning pituitary macroadenomas. Int J Radiat Oncol Biol Phys. 2005 Mar 1. 61(3):795-808. [Medline].

  12. Han S, Ding X, Tie X, Liu Y, Xia J, Yan A, et al. Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: Is one nostril enough?. Acta Neurochir (Wien). 2013 Jun 5. [Medline].

  13. Mao ZG, Zhu YH, Tang HL, et al. Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomized trial. Eur J Endocrinol. 2010 Jan 8. [Medline].

  14. Przybylowski CJ, Dallapiazza RF, Williams BJ, et al. Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study. J Neurosurg. 2016 May 20. 1-8. [Medline].

  15. Magro E, Graillon T, Lassave J, et al. Complications Related to the Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients. World Neurosurg. 2016 May. 89:442-53. [Medline].

  16. Sankhla SK, Jayashankar N, Khan GM. Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: early experience. Neurol India. 2013 Mar-Apr. 61(2):122-30. [Medline].

  17. Berkmann S, Fandino J, Zosso S, et al. Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg. 2011 Sep. 115(3):518-27. [Medline].

  18. Elhateer H, Muanza T, Roberge D, et al. Fractionated stereotactic radiotherapy in the treatment of pituitary macroadenomas. Curr Oncol. 2008 Dec. 15(6):286-92. [Medline]. [Full Text].

  19. Schalin-Jäntti C, Valanne L, Tenhunen M, et al. Outcome of Fractionated Stereotactic Radiotherapy in Patients with Pituitary Adenomas Resistant to Conventional Treatments: a 5.25- yr Follow-up Study. Clin Endocrinol (Oxf). 2009 Dec 18. [Medline].

  20. Mello PA, Naves LA, Pereira Neto A, Oliveira EH, Ferreira IC, Araújo Júnior AS, et al. Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas. Arq Neuropsiquiatr. 2013 May. 71(5):307-12. [Medline].

  21. Hwang YC, Chung JH, Min YK, et al. Comparisons between macroadenomas and microadenomas in Cushing's disease: characteristics of hormone secretion and clinical outcomes. J Korean Med Sci. 2009 Feb. 24(1):46-51. [Medline]. [Full Text].

  22. Fernandez-Balsells MM, Murad MH, Barwise A, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011 Apr. 96(4):905-12. [Medline].

  23. Bardin CW. Anterior pituitary disease. Current Therapy in Endocrinology and Metabolism. 6th ed. St. Louis, Mo: Mosby Year Book; 1997. 33-8.

  24. Becker KL, Bilezikian JP, Bremner WJ. Adenohypophysis. Principles and Practice of Endocrinology and Metabolism. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1995. 207-37.

  25. Mulinda JR, Hasinski S, Rose LI. Successful therapy for a mixed thyrotropin-and prolactin-secreting pituitary macroadenoma with cabergoline. Endocr Pract. 1999 Mar-Apr. 5(2):76-9. [Medline].

  26. Takahashi T, Miki Y, Takahashi JA, et al. Ectopic posterior pituitary high signal in preoperative and postoperative macroadenomas: dynamic MR imaging. Eur J Radiol. 2005 Jul. 55(1):84-91. [Medline].

  27. Wilson JD, Foster DW. Pituitary disorders. Williams Textbook of Endocrinology. 8th ed. Philadelphia, Pa: W.B. Saunders, Co; 1992. 260-95.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.