Abstract
PurposeNon-functioning pituitary adenomas (NFPAs) are associated with impaired well-being, increased comorbidities, and reduced long-term survival. Data on optimal management of NFPAs around surgical treatment are scarce, and postoperative treatment and follow-up strategies have not been evaluated in prospective trials. Here, we review the preoperative, perioperative, and early postoperative management of patients with NFPAs.MethodsWe searched Medline and the Cochrane Library for articles published in English with the following items “Pituitary neoplasms AND Surgery” and “Surgery AND Hypopituitarism”. Studies containing detailed analyses of the management of NFPAs in adult patients, including pituitary surgery, endocrine care, imaging, ophthalmologic assessment and long-term outcome were reviewed.ResultsTreatment options for NFPAs include active surveillance, surgical resection, and radiotherapy. Pituitary surgery is currently recommended as first-line treatment in patients with visual impairment due to adenomas compressing the optic nerves or chiasma. Radiotherapy is reserved for large tumor remnants or tumor recurrence following one or more surgical attempts. There is no consensus of optimal pre-, peri-, and postoperative management such as timing, frequency, and duration of endocrine, radiologic, and ophthalmologic assessments as well as management of smaller tumor remnants or tumor recurrence.ConclusionsIn clinical practice, there is a great variation in the treatment and follow-up of patients with NFPAs. We have, based on available data, suggested an optimal management strategy for patients with NFPAs in relation to pituitary surgery. Prospective trials oriented at drawing up strategies for the management of NFPAs are needed.
Highlights
Non-functioning pituitary adenomas (NFPAs) are benign tumors arising from the adenohypophyseal cells characterized by the absence of clinical evidence of hormonal1 3 Vol:.(1234567890)hypersecretion
In this paper we have reviewed the pre, peri- and postoperative management of patients with NFPAs
Despite being histologically benign tumors, NFPAs are associated with long-term comorbidities, impaired well-being, and reduced long-term survival
Summary
Non-functioning pituitary adenomas (NFPAs) are benign tumors arising from the adenohypophyseal cells characterized by the absence of clinical evidence of hormonal. Marko et al [84] studied 100 patients undergoing pituitary surgery and found that postoperative cortisol level ≥ 15 μg/ dL (≥ 417 nmol/L using an immunoassay) was a sensitive and accurate predictor of normal postoperative HPA axis function, with a positive predictive value of 99%. Some studies have reported that HPA axis dysfunction in the early postoperative period may normalize 1–3 months after surgery, suggesting that neither SST nor ITT is helpful immediately after surgery and patients should be tested later [90, 91]. Raverot et al [124] have suggested a classification of pituitary tumors into five grades that can be used by clinicians to predict tumor behavior postoperatively This grading system is based on predictor factors, such as tumor invasion on MRI, immunohistochemical profile, mitotic index, Ki-67, and p53 positivity that can be used to identify patients with high risk of tumor recurrence or progression [124]. This positive development could be explained by the decreasing prevalence of hypopituitarism recorded over time, that could be an effect of improved surgical techniques [132]
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