Pituitary Macroadenomas Follow-up
- Author: James R Mulinda, MD, FACP; Chief Editor: George T Griffing, MD more...
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.
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.
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 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.
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.
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.
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]).
Patient education and support groups include the Pituitary Network Association.
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