Pituitary Macroadenomas Follow-up

Author: James R Mulinda, MD, FACP, FACE; Chief Editor: George T Griffing, MD more...

Updated: Oct 17, 2011

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Further Inpatient Care
Further Outpatient Care
Inpatient & Outpatient Medications
Complications
Prognosis
Patient Education
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References

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.

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.^[14]

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]).^[15]

Patient Education

Patient education and support groups include the Pituitary Network Association.

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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

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.