Book ChapterDOI
Nonfunctioning Pituitary Adenoma: Management
Melanie Schorr
- pp 21-29
TLDR
Since nonfunctioningpituitary adenomas do not present with a clinical syndrome of pituitary hormone excess, common presentations include neurologic symptoms such as visual impairment and/or headache, symptoms of pituitsary hormone deficiency, or an incidental sellar mass on an imaging study.Abstract:
Since nonfunctioning pituitary adenomas do not present with a clinical syndrome of pituitary hormone excess, common presentations include neurologic symptoms such as visual impairment and/or headache, symptoms of pituitary hormone deficiency, or an incidental sellar mass on an imaging study. The evaluation of a newly diagnosed pituitary adenoma should include a detailed history and physical exam, a dedicated pituitary MRI, biochemical evaluation of pituitary hormone excess and deficiency, and visual field and acuity testing if clinically indicated. Vision impairment due to optic chiasm compression is a clear indication for transsphenoidal surgery. Transsphenoidal surgery may also be considered in cases of high risk of visual impairment, clinically significant tumor growth, and/or hypopituitarism. Transsphenoidal surgery is typically successful in reducing tumor volume and improving vision and is less successful in reversing hypopituitarism. If there is little or no residual adenoma on pituitary MRI, the patient should still be monitored for recurrence with serial pituitary MRI scans. If there is significant residual adenoma on pituitary MRI or progressive adenoma regrowth after surgery, postoperative radiation therapy may be considered.read more
References
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Journal ArticleDOI
Pituitary incidentaloma: an endocrine society clinical practice guideline.
Pamela U. Freda,Albert Beckers,Laurence Katznelson,Mark E. Molitch,Victor M. Montori,Kalmon D. Post,Mary Lee Vance +6 more
TL;DR: Practice guidelines for the endocrine evaluation and treatment of pituitary incidentalomas are presented, including indications for surgery.
Journal ArticleDOI
UK guidelines for the management of pituitary apoplexy
Senthil Rajasekaran,Mark Vanderpump,Stephanie E Baldeweg,W. M. Drake,Narenda Lakshmana Reddy,Marian Lanyon,Andrew Markey,Gordon T. Plant,Michael Powell,Saurabh Sinha,John A.H. Wass +10 more
TL;DR: It is suggested that further trials be carried out into the management of pituitary apoplexy to optimize treatment.
Journal ArticleDOI
Differential diagnosis of sellar masses
Pamela U. Freda,Kalmon D. Post +1 more
TL;DR: An overview of the clinical and radiographic characteristics of both pituitary tumors and the nonpituitary lesions found in the sellar/parasellar region is provided and discusses, in detail, the specific non Pituitary origins of the Sellar masses.
Journal ArticleDOI
Results of transsphenoidal surgery in a large series of patients with pituitary adenoma.
TL;DR: Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in all cases except for prolactinomas responsive to dopamine agonists.
Journal ArticleDOI
Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma.
Olaf M. Dekkers,Alberto M. Pereira,Ferdinand Roelfsema,J. H. C. Voormolen,Karen J. Neelis,Marielle A Schroijen,J. W. A. Smit,J. A. Romijn +7 more
TL;DR: Transsphenoidal surgery without postoperative radiotherapy is an effective and safe treatment strategy for NFMA, without evidence for tumor regrowth in 90% of all patients, at least for the duration of follow-up, as evaluated in this study.