Endocrine Abstracts

Introduction: Pituitary adenomas with cavernous sinus involvement (CSI) are associated with serious clinical sequelae but are often incompletely excised during surgery. Contradictory viewpoints exist regarding management of residual tumors in the cavernous sinus with some authors suggesting use of adjuvant radiotherapy post-operatively for long term tumor control. But radiotherapy has been associated with hypopituitarism and increased mortality due to cerebrovascular causes. We investigated the clinical outcome of pituitary adenomas in the cavernous sinus.

Methods: Patients with pituitary adenoma and CSI (diagnosed radiologically±surgical exploration) and subsequently managed with surgery alone (S), radiotherapy alone (R), surgery with adjuvant radiotherapy (S+R) or medical management (M) were prospectively observed for adverse clinical events. Adverse clinical events were defined as i) impingement on cranial nerves (III, IV, V1, V2 and VI) situated in the cavernous sinus and ii) increase in size of the residual tumor of more than 30%. Data are as mean±S.D.

Results: Sixty patients (31 males, 29 females) with pituitary adenomas (31 non functioning pituitary adenoma, 16 acromegaly, 4 cushing’s disease, 9 prolactinoma) with age at CSI diagnosis 51.4±14.5 years, were followed up post CSI for 67.4±50.1 months. Thirty-four patients were managed with S, 6 with S+R, 2 with R and 18 with M. Patients in all four groups had stable disease and no adverse clinical events were noted over this follow-up period.

Conclusion: The outcome with post-operative radiotherapy for residual pituitary adenomas was similar to management with surgery or radiotherapy alone. Moreover, medical management alone, in selected cases, also yielded similar results. From this data, it appears that risk of progression of the residual pituitary adenoma in the cavernous sinus is low and routine radiotherapy for prophylaxis in this sub-group may not be justified.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.