Endocrine Abstracts

Our Pituitary Tumour Registry includes data about 346 patients with pituitary macroadenomas: 142 non-functional adenomas (NFA) including 18 (12.7%) giant, 62 macroprolactinomas – 6 (9.7%) giant, 141 somatotropinomas – 6 (4.3%) giant. We analysed clinical features of these 30 giant pituitary tumors (<40 mm at least one of the sizes): 18 NFA (11 Females; 7 Males), 6 prolactinomas (3 Females; 3 Males), 6 somatotropinomas (3 Females; 3 Males). Patients with giant NFA were of the same age as others with NFA, however patients with giant prolactinomas and somatotropinomas were 10–15 years younger than mean age of their group.

According to MRI data pituitary sizes were: NFA – sagittal 28–56 mm (35 [31; 43] mm); vertical 23–51 mm (42 [33; 45] mm), frontal 26–62 mm (42 [36; 46] mm); prolactinomas – sagittal 40–62 mm (43.5 [41.5; 59] mm), vertical 25–65 mm (46 [37; 56] mm), frontal 30–62 mm (50 [32; 58] mm); somatotropinomas – sagittal 23–67 mm (53 [39.5; 65.5] mm), vertical 30–61 mm (49.5 [40; 54], frontal 34–60 mm (47 [37; 60] mm).

Pituitary tumour volumes were: NFA 16,998–68,753 mm³ (Median 28,190 [21,143; 44,896] mm³); prolactinomas 16,876–130,760 mm³ (48,091 [30,331;97,843] mm³; and somatotropinomas 19,644–124,501 mm³ (51,209 [36,703;102,207] mm³). The most often observed tumour growth directions were supra-latero-infrasellar (n=19, 63.3%), and supra-latero-sellar (n=6.20%). Chiasm compression visualized on MR-images in 24 (80%) patients (18 NFA, 3 prolactinomas and 3 somatotropinomas).

Main complains were visual impairment (18 patients, 60%) and headache (12 patients, 40%), and most often “first referred” specialists were ophthalmologist and neurologist in 15 (50%) and 11 (36.7%) cases, accordingly. Hypopituitarism before any treatment was found in 10 (33.3%) cases (7 NFA, 1 prolactinoma, 2 somatotropinomas), all tumors had vertical size >40 mm and significant suprasellar extension.

Thus, age <50 y.o. and tumor volume >70,000 mm³ were predictors of hormonal activity of giant adenoma; vertical size >40 mm and suprasellar extension were predictors of hypopituitarism; ophthalmologist and neurologist should be aware of giant adenomas.