Pituitary Microadenomas Follow-up

Updated: Apr 21, 2020
  • Author: Bernard Corenblum, MD, FRCPC; Chief Editor: George T Griffing, MD  more...
  • Print
Follow-up

Further Outpatient Care

The natural history for nonfunctioning microadenomas appears to be benign. [11, 20] Follow-up MRI scans can be performed at 12 months to assess progression, but generally they are not needed for most microadenomas, For nonsecreting adenomas, follow-up is usually not needed unless clinical symptoms arise. If the tumor enlarges, full endocrine testing and therapy are justified.

This was supported by a retrospective, observational study by Thaker et al, which found that in 78 children with nonfunctioning pituitary lesions identified as cysts or presumed or possible microadenomas, the lesions followed a benign course. Over an average clinical follow-up period of 4.5 years, the lesions did not significantly increase in size, and pituitary function did not significantly worsen. The investigators stated that if new endocrine or visual symptoms do not present in children whose pituitary lesions—cysts or microadenomas—are asymptomatic, these patients may not need repeat MRI examination; if it is carried out, they say, it should be performed in no less than a year. [26]

Next:

Inpatient & Outpatient Medications

If the tumor is secreting excess hormone, initiate appropriate medical therapy as described in the articles Hyperprolactinemia, Acromegaly, and Cushing disease.

Previous
Next:

Complications

Complications are caused by the rare enlargement of the tumor to a macroadenoma or by excessive hormone secretion.

Inactive microadenomas rarely cause complications unless they are pressing on the pituitary stalk.

Previous
Next:

Prognosis

Prognosis depends on the hormonal activity of the adenoma. [10] Most incidentalomas are inactive and do not cause morbidity, except morbidity related to excessive investigation. Patient anxiety may result from the discovery of the microadenoma, and appropriate support may be needed. A meta-analysis showed that microadenomas rarely enlarge (3.3 per 100 patient-years [95% confidence interval, 2.1-4.5]). [5]

A retrospective study by Guaraldi et al indicated that the great majority of patients with Cushing disease can achieve long-term remission through selective adenomectomy (carried out by experienced surgeons with dedicated, multidisciplinary team support). The study looked at 151 patients with Cushing disease, including 35 with a macroadenoma, 80 with a microadenoma, and 36 in whom a tumor could not be detected on MRI. In addition, 88.7% of patients were treatment naïve, while 11.3% had previously undergone surgical treatment, and 11.2% had previously undergone medical treatment. The investigators found that at mean 92.3-month follow-up, the remission rate was 90.7%. Within the cohort, diabetes insipidus and hypopituitarism developed in 27 and 18 patients, respectively. [27]

Previous
Next:

Patient Education

The patient must be informed of the frequency of incidentalomas and the benign nature of those that do not enlarge or secrete excess hormone.

For excellent patient education resources, visit eMedicineHealth's Women's Health Center and Men's Health Center. Also, see eMedicineHealth's patient education articles Amenorrhea and Impotence/Erectile Dysfunction.

Previous