Endocrine Abstracts

Objective: To assess clinical outcome after pituitary surgery in patients nonfunctioning pituitary adenomas (NFPA) surgically treated in the past 3 decades in three tertiary referral hospitals.

Methods: A multicenter retrospective study on clinical and pathological characteristics, treatment patterns, and outcome in patients with NFPA periodically followed up in specialized neuroendocrinology units who underwent surgery in the period 1982–2015 was performed.

Results: 105 patients [54 women (51.4%)]; age 52.26±14.07 yr were studied. The tumor was sporadic in 100 patients (95.2%) and in the context of a multiple endocrine neoplasia type 1 in 5 patients (4.8%; 4 women). The main reasons for consultation were neuro-ophthalmologic symptoms such as visual disturbances (71.4%) and headaches (44.8%). In the analysis of symptoms by sex, panhypopituitarism (P=0.004), central hypogonadism (P=0.002), and secondary hypothyroidism (P=0.003) were more commonly observed in men. 90.5% of the cases were macroadenomas (n=95), 15 of them (15.8%) giant adenomas (≥4 cm). Immunohistochemical staining was mainly positive for LH (17.1%) and FSH (15.2%). Ki67 index was studied in 41 patients, showing the majority (43.9%) a value <1%. After a median of 57 months of follow-up, maximum tumor diameter decreased from 2.9±1.0 to 1.2±1.2 cm (P<0.001); the percentage of patients with no tumor on MRI was 25.7%. The percentage of patients with pathological visual fields decreased from 66.6% to 33.6%; whereas, panhypopituitarism increased from 6.7% to 14.3%. Surgery achieved complete cure (absence of tumor and normal pituitary function) in 12 patients (11.4%).

Conclusion: NFPAs surgically treated in our country show a similar distribution between men and women, although they are clinically more symptomatic in the first. Histologically, NFPAs are usually gonadotropinomas with low proliferation index. Although therapy is accompanied by improvement in visual fields, involvement of pituitary function does not improve over time. Complete cure is uncommon and long-term follow-up is needed.