Endocrine Abstracts

Introduction: The non-functional pituitary adenoma (NFPA) is a benign tumor, which has a progressive development but it is a severe tumor by its neuro-ophthalmological and endocrine repercussions.

Patients and methods: It is about a descriptive and retrospective study conducted in 35 patients collected in the endocrinology department of Sfax between January 2000 and December 2017. The diagnosis of NFPA was based on the presence of pituitary adenoma on hypothalamic-pituitary imaging and the absence of clinical and biological signs of hormonal hypersecretion.

Results: Thrity-five patients were enrolled including 20 men (57.14%) and 15 women (42.28%). The average age of our patients was 49.23 years old with a sex ratio of 1.33. Pituitary tumor syndrome was the most common mode of discovery (85.7%). On imagery, a micro-adenoma was found in 8.57% of cases, a macro-adenoma in 77.14% of cases and a giant HA in 14.28% of cases. Suprasellar invasion was found in 71.42% of cases. These NFPA were complicated by pituitary insufficiency in 81.5% of cases. Gonadotropic insufficiency was the most common, found in 54.28% of cases. Adrenocorticotropic insufficiency and thyrotropic insufficiency were found in 37.14% and 38.28% of cases, respectively. Hyperprolactinemia of disconnection was observed in 28.57% of cases. The majority of our patients were operated on (62.85%) in the presence of neuro-ophthalmological disorders, endocrine disorders and pituitary apoplexy associated with neurological disorders.The immunohistochemical study showed 7 cases of null cell adenoma and 6 cases of silent pituitary adenoma. It was uninterpretable in 3 cases for almost total necrosis. Surgical complications were dominated by transient diabetes insipidus (18.18%), transient rhinorrhea and postoperative hyperphagia were found in 9.09% of cases each, bleeding and meningitis were found in 4.55% of cases each. Among our operated patients, 15 were regularly followed in the medium and long term, an improvement of the pituitary tumoral syndrome in the majority of patients (66%), an aggravation or appearance of a pituitary insufficiency in 12 patients (80%). Postoperative MRI revealed tumor residue in 6 cases and tumor recurrence in only one case. The average duration of follow-up in postoperative patients was approximately 18 months (extremes: 12 months – 3 years). Therapeutic abstention was indicated in 12 patients. The follow-up of these patients shows a stable clinical, biological and radiological state.

Conclusion: NFPA are benign, rare but serious tumors. It is a heterogeneous group by its clinical manifestations, its hormonal and ophthalmological impact.