eMedicine Specialties > Endocrinology > Pituitary Gland

Pituitary Macroadenomas: Follow-up

Author: James R Mulinda, MD, FACP, FACE, Consulting Staff, Department of Endocrinology, Endocrinology Associates, Inc
Contributor Information and Disclosures

Updated: Aug 3, 2009

Follow-up

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.

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.

Inpatient & Outpatient Medications

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

Complications

Complications result from mass effects and abnormal hormone function.

  • 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.

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.6

Patient Education

Patient education and support groups include the Pituitary Network Association.

Miscellaneous

Medicolegal Pitfalls

  • Prior to treating patients with secondary hormone deficiencies, pituitary imaging should be performed.
  • Monitor patients who undergo radiation therapy for late pituitary failure.
    • Macroadenomas may present initially with pituitary apoplexy.
    • Macroadenomas may cause masked secondary adrenal insufficiency.
  • Adrenal insufficiency and hypothyroidism may mask diabetes insipidus. Watch for diabetes insipidus when starting hormonal replacement.

Special Concerns

  • 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 associated with lymphocytic hypophysitis, an autoimmune inflammatory lesion of the pituitary that often presents with adrenal insufficiency.
 


More on Pituitary Macroadenomas

Overview: Pituitary Macroadenomas
Differential Diagnoses & Workup: Pituitary Macroadenomas
Treatment & Medication: Pituitary Macroadenomas
Follow-up: Pituitary Macroadenomas
References
Further Reading
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References

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

  2. 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. Jul 2009;65(1):63-70; discussion 70-1. [Medline].

  3. 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. Jun 2009;111(5):442-9. [Medline].

  4. 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. Mar 1 2005;61(3):795-808. [Medline].

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

  6. 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. Feb 2009;24(1):46-51. [Medline]. [Full Text].

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

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

  9. Biller BM, Molitch ME, Vance ML, Cannistraro KB, Davis KR, Simons JA, et al. Treatment of prolactin-secreting macroadenomas with the once-weekly dopamine agonist cabergoline. J Clin Endocrinol Metab. Jun 1996;81(6):2338-43. [Medline].

  10. Diez JJ, Iglesias P. Current management of acromegaly. Expert Opin Pharmacother. Jul 2000;1(5):991-1006. [Medline].

  11. Manieri C, Di Bisceglie C, Razzore P, et al. Gonadotroph cell pituitary adenomas in males. Panminerva Med. Dec 2000;42(4):237-40. [Medline].

  12. Martin CH, Schwartz R, Jolesz F, et al. Transsphenoidal resection of pituitary adenomas in an intraoperative MRI unit. Pituitary. Aug 1999;2(2):155-62. [Medline].

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

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

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

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Keywords

pituitary macroadenoma, pituitary, pituitary gland, tumor pituitary, pituitary adenoma, prolactinoma, microadenoma, tumor pituitary gland, pituitary hormone, pituitary hormones, pituitary tumor, pituitary tumors, pituitary macroadenomas, hypophyseal adenoma, multiple endocrine neoplasia type 1, MEN 1, acromegaly, McCune-Albright syndrome, epithelial pituitary cells

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Contributor Information and Disclosures

Author

James R Mulinda, MD, FACP, FACE, Consulting Staff, Department of Endocrinology, Endocrinology Associates, Inc
James R Mulinda, MD, FACP, FACE is a member of the following medical societies: American College of Clinical Endocrinologists and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Dimitris A Papanicolaou, MD, Assistant Professor, Department of Medicine/Endocrinology, Emory University
Dimitris A Papanicolaou, MD is a member of the following medical societies: American College of Physicians, Endocrine Society, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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 Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor 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, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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