Endocrine Abstracts

Introduction: Clinically nonfunctioning pituitary adenomas (CNFPA) represent 25–50% of all pituitary lesions. They may be asymptomatic and discovered incidentally or they may be diagnosed due to visual impairment or symptoms of pituitary hormone insufficiency. There is little data on apoplexy frequency in the CNFPA.

The aim of our study was to assess the frequency of CNFPA among all pituitary adenomas and additionally to evaluate how common is apoplexy as an initial presentation in these adenomas.

Design: We studied retrospectively all patients who were admitted and diagnosed with a pituitary adenoma in our department, during the last 10 years. For this purpose, patients’ charts were reviewed for clinical features upon admission, laboratory and magnetic resonance findings during hospitalization and histopathological results after surgical treatment.

Results: We identified 116 patients with pituitary adenomas and 42 (27.6%) of them had a CNFPA (26 men and 16 women). The remaining 74 (72.3%) had other types of sellar lesions such as prolactinomas, somatotropinomas, Rathke’s cysts or craniopharyngiomas. Upon admission, 45% of patients with CNFPA presented with both symptoms of pituitary hormone insufficiency and vision impairment, 30% only with pituitary insufficiency, 15% only with symptoms of vision impairment and finally 10% presented with non-specific symptoms such as headache and weakness. Among patients with CNFPA, 14 (33.3%) were revealed to have gonadotropinomas (five men and four women). Pituitary apoplexy was at the initial presentation in six male patients (14.3%) and half of them had gonadotropinomas. Patients with pituitary apoplexy presented bigger lesions (P<0.05) and those with a preexisting gonadotropinoma were younger (P<0.05) compared to patients without pituitary apoplexy.

Conclusions: CNFPA represent a significant percent of all pituitary adenomas. Pituitary apoplexy is not unusual at initial presentation, especially in younger men with greater sellar lesions.