Follow-up of invasive pituitary macroadenoma in 56 patients within a duration of 5 years.

Abstract

From June 1986 to September 1996, 56(30%) patients with invasive pituitary macroadenoma were studied retrospectively. We compared the clinical and endocrinological characteristics, neuroimaging findings, and surgical outcome of these patients in a period of follow up of 5 years. Twenty-one patients (38%) were found to have a prolactinoma, 8 patients (14%) had a GH-producing adenoma, and 27 patients (48%) had non-functional tumors. Pituitary apoplexy was found in 16 cases (29%). Their age ranged from 15 to 72 years and no sex difference (F:M = 27:29) was found. According to Hardy's classification, all the 56 tumors were invasive pituitary macroadenoma, of a tumor size more than 10 mm with sellar floor erosion partially or diffusely or paracarvenous sinus invasion. Those tumors were divided into grade III (tumor causing localized perforation of the sellar floor), and IV (tumor destroying entire sellar floor diffusely); the tumors were further subdivided into stage C (3rd ventricle grossly displaced), D (intracranial intradural extension) and E (tumors invading the cavernous sinus through the lateral dural envelope of the sellar). Eight out of 56 tumors belonged to grade III stage C, 18 tumors were grade III stage D, 8 tumors were grade IV stage D, and the other 22 were grade IV stage E. Fifty-one patients received transsphenoidal craniectomy for tumor removal, one patient took subfrontal craniotomy only and 4 cases received both. Most patients improved significantly in visual field and general quality of life after surgery. In this study, it was concluded that: 1) surgical intervention as quick as possible was proven advantageous, especially in patients with an invasive macroadenoma; 2) in cases with invasive pituitary macroadenomas, the patients, with grade III and IV tumors, had a longer symptom-free interval than those who refused surgical intervention and radiotherapy with the same grade tumor; 3) to achieve satisfactory late results, multidisciplinary treatment was necessary: post-operative radiotherapy ranging from 4500 to 6500 rads was done in 50 patients, endocrine therapy in 52 patients and adjunct bromocriptine treatment was done in 13 patients with prolactinomas; 4) symptomatic recurrence or elevated postoperative hormone levels occurred in 20(35%) cases. There was a high incidence of recurrence in 6(6/20) GH-secreting tumors, and in 8(8/20) prolactinomas with preoperative prolactin levels more than 200 eta g/dl.