ICEECE2012 Poster Presentations Pituitary Clinical (183 abstracts)
Asymptomatic nonfunctioning pituitary macroadenomas take advantage of surgery
J. Dubourg 1 , M. Messerer 2 , R. Daniel 2 , D. Bervini 2 , M. Berhouma 3 , G. Perrin 4 , G. Iype 4 , A. Chacko 4 , J. Trouillas 5, , G. Raverot 1, & E. Jouanneau 3,
1Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 2Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 3Hôpital Neurologique Pierre Wertheimer, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 4Christian Medical College, Vellore, India; 5Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 6INSERM U1028, CNRS UMR5292, Université Lyon1, Lyon, France.
Introduction: Pituitary incidentalomas (PIs) defined as pituitary tumors discovered by systematic neuroimaging constitute an increasingly clinical problem. Most of PIs are nonfunctioning tumors (NFPIs) with systematic investigation revealing visual and/or endocrinological impairment in some patients while others remained asymptomatic. If the therapeutic management is well codified for functioning PIs and symptomatic NFPIs, a debate still remain for asymptomatic NFPIs between surgery and a “wait and see” approach.
Design: To answer this point, we conducted a retrospective study on 76 patients with newly diagnosed symptomatic or asymptomatic NFPIs operated on from 2005 to 2011 by three experimented neurosurgeons. We compared age, tumor size and surgical results (quality of resection, endocrinological and ophthalmological results, morbidity) of the two patient groups.
Results: After the initial exploration, 48 (63%) patients were symptomatic and 28 were asymptomatic. Mean age (60.9±13.1 versus 52.9±11.9 years) and tumor height (25±6 versus 20±7 mm) were significantly higher in symptomatic compare to asymptomatic patients (P<0.001, P<0.01, respectively). There was no significant difference regarding the Knosp’s classification. Gross total removal was significantly better in asymptomatic (82%) than in symptomatic patients (58%; P=0.03). Postoperative pituitary function was normalized/improved (41%), unchanged (48%) or worsened (11%) in the 27 symptomatic patients with initial endocrinological impairment. It was worsened in 19% of the symptomatic patients without preoperative endocrinological impairment versus 14% in asymptomatic patients (P=0.7). The postoperative ophthalmological function was normalized/improved (88%) or unchanged (12%) in the 35 symptomatic patients with initial ophthalmological impairment whereas there was no worsening in all other patients. No significant difference was found regarding postoperative morbidity: cerebrospinal fluid leakage (5%), meningitis (1%), epistaxis (1%) and definitive diabetes insipidus (2.5%).
Conclusions: The knowledge that natural history of NFPIs makes them symptomatic and the quality of the resection without worsening of visual function give arguments to propose surgery for asymptomatic macro NFPIs by experimented neurosurgeons.
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.
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Endocrine Abstracts
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