Nonfunctioning pituitary tumors

Published on 02/03/2015 by admin

Filed under Endocrinology, Diabetes and Metabolism

Last modified 22/04/2025

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CHAPTER 19

Nonfunctioning pituitary tumors

1. Name the functioning pituitary tumors.

2. What is a nonfunctioning pituitary tumor?

3. What is the alpha subunit?

4. What other lesions can resemble nonfunctioning pituitary tumors?

5. Differentiate between a microadenoma and a macroadenoma.

6. Which structures may be damaged by growth of a pituitary tumor outside the sella turcica?

7. What are the clinical features of nonfunctioning pituitary tumors?

8. What anatomic evaluation is necessary for a pituitary tumor?

9. What evaluation is necessary to determine that a pituitary tumor is nonfunctioning?

10. Does an elevated serum prolactin value indicate that a tumor is functioning?

11. What is the natural history of nonfunctioning pituitary tumors?

12. What is the primary treatment for a nonfunctioning pituitary tumor?

A microadenoma can be managed with observation by serial imaging studies. Surgical removal should be considered for a macroadenoma; however, serial observation is an option if the tumor is not growing or causing compressive symptoms.

The treatment of choice for symptomatic tumors is transsphenoidal pituitary surgery. Primary radiation therapy may be used if surgery is contraindicated or not desired. Medications, such as dopamine agonists (bromocriptine, cabergoline) and somatostatin analogs (octreotide, lanreotide) are rarely helpful in the treatment of nonfunctioning pituitary tumors.

13. Is postoperative radiation therapy recommended for incompletely resected tumors?

14. What endocrine complications occur in the immediate postoperative period?

15. What is the management of postoperative diabetes insipidus and water intoxication?

16. What endocrine problems may occur during long-term follow-up?

Deficiencies of other pituitary hormones may develop weeks, months, or years later, especially if radiation therapy was given. The only major concern in the first month is adrenal insufficiency. During this time, one should question patients about suggestive symptoms and, if present, measure a morning cortisol level. If the morning cortisol level is low (<10 μg/dL), hydrocortisone replacement should be initiated, and the patient retested in 3 to 6 months with a cosyntropin stimulation test. At that time, levels of serum free thyroxine (T4), TSH, IGF-1, LH, FSH, testosterone (men), and estradiol (women) should also be checked, and replacement therapy considered for any identified deficiencies. It is recommended that these levels then be monitored at 6 months, 1 year, and annually thereafter.

17. Summarize the long-term management of pituitary insufficiency.

See Table 19-1.

TABLE 19-1.

LONG-TERM MANAGEMENT OF PITUITARY INSUFFICIENCY

HORMONE DISORDER MANAGEMENT
Adrenal insufficiency Physiological glucocorticoid replacement
Hypothyroidism Levothyroxine replacement
Hypogonadism (men) Androgen gels, patches, or injections
Hypogonadism (women) Oral or transdermal contraceptives or postmenopausal hormone replacement
Growth hormone (GH) Growth hormone replacement
Diabetes insipidus Desmopressin nasal spray or oral tablets

18. Describe the clinical features of pituitary carcinomas.

19. What is the treatment for pituitary carcinoma?

20. What is the prognosis for pituitary carcinoma?

21. Which cancers metastasize to the pituitary gland?

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