ECE2010 Poster Presentations Neuroendocrinology and Pituitary (<emphasis role="italic">Generously supported by Novartis</emphasis>) (125 abstracts)
Incidentally found nonfunctioning pituitary macroadenomas: should we suspect them earlier?
Leonor Gomes 1 , Isabel Paiva 1 , Cristina Ribeiro 1 , Jacinta Santos 1 , Alexandra Vieira 1 , Mariana Martinho 2 , Márcia Alves 1 , Sofia Gouveia 1 , Manuel Rito 3 , Francisco Belo 3 , Olinda Rebelo 4 & Manuela Carvalheiro 1
1Serviço de Endocrinologia, Diabetes e Metabolismo dos Hospitais da Universidade de Coimbra-EPE, Coimbra, Portugal; 2Serviço de Endocrinologia do Instituto Português de Oncologia Francisco Gentil de Coimbra-EPE, Coimbra, Portugal; 3Serviço de Neurocirurgia dos Hospitais da Universidade de Coimbra-EPE, Coimbra, Portugal; 4Laboratório de Neuropatologia do Serviço de Neurologia dos Hospitais da Universidade de Coimbra-EPE, Coimbra, Portugal.
Background: Nonfunctioning pituitary adenomas are commonly diagnosed as large tumors. Most are detected incidentally during imaging studies. The aim of this study was to evaluate clinical presentation, characteristics and outcome of nonfunctioning pituitary macroadenomas incidentally (NFPMI) discovered.
Methods: Twenty-seven patients (mean age 58.9 years, 45–82; 18 males:9 females) with NFPMI were studied. They represent 13.1% of NFPM followed in our department. The reasons for neuroradiological studies were head trauma in 4 (14.8%); cerebral attacks in 12 (44.4%); sinusitis in 4 (14.8%); lipothymia/syncope in 3 (11.1%); hypoacusia 2 (7.4%) and cancer staging in 2 (7.4%).
Results: Of 62.9% had symptoms related with macroadenomas: vision alterations in 4 (14.8%); headache, dizziness, confusion, memory loss in 13 (48.1%); sexual dysfunction in 4 (14.8%) and amenorrhea in 2 (7.4%). Endocrinological evaluation showed global anterior hypopituitarism in one (14.2%) and partial hypopituitarism in 72.7%. Visual deficits were present in 15 (71.4%) patients. At MRI there was suprasselar extension in all cases, parasellar in 8 (29.6%) and infrasellar in 9 (33.3%). Mean diameter was 25.3 mm (15–49.7 mm). Surgery was performed in all but four patients and two underwent also radiotherapy. Immunohistochemistry showed eighteen nonsecreting adenomas, two FSH, one ACTH, one TSH and two inconclusive. Surgery was highly effective in improving vision alterations (62.5%) but was enable to restore normal pituitary function in most cases. Five patients were lost for followed-up. At last MRI (mean follow-up 4.5 years, 6 months–17 years) 6 (27.2%) patients were free of disease, 15 (68.1%) had remnants and one is waiting surgery.
Conclusions: NFPMI were very frequent among NFPM. Symptoms related to the macroadenomas were often overlooked. Hypopituitarism (86.9%) and vision alterations (71.4%) were high and only the last one recovered with surgery. It is important to be aware of the neurological and endocrinological symptoms in order to perform earlier diagnosis. This can avoid exposing patients to the risks of unrecognized hypopituitarism, permanent visual deficits and jeopardizing post-surgical outcome.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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