Evaluation of clinical, laboratory characteristics and treatment modalities of pituitary adenomas: single center experience

Abstract

Pituitary adenoma is a group of disease with a broad different clinical characteristics and complications. We aimed to present the data of patients being followed in a single center and discuss the pituitary adenomas based on the lierature. Two hundreds and twenty patients followed at Department of Endocrinology and Metabolism, Medical School of Ondokuz Mayis University, were included into study. Clinical characterisitics, laboratory findings and treatment modalities were examined retrospectively. 59% of patients were female and 41% were male. Mean age during the diagnosis was 43.7 years. 62% of the adenoma was macroadenoma. 73% of adenomas was functional. Among the functional adenomas, the most seen types were prolactin-secreting adenoma and growth-hormone secreting adenoma. 67% surgical treatment, 20% medical treatment and 7% radiotherapy were applied to our patients. Post-operative complications were developed in 21 of patiens. In patients with non-functional adenoma, the cure after surgery was detected as 19.6% and the remission after the surgery was detected as 8.9%. In this study, the characteristics of the pituitary adenomas were found similar to the literature generally. The early diagnosis of the disease has a significant importance in terms of treatment and the response to the treatment.

Keywords

• Pituitary adenoma,prolactinoma,, acromegaly,cushing disease

References

1. Agustsson, T.T., Baldvinsdottir, T., Jonasson, J.G., Olafsdottir, E., Steinthorsdottir, V., Sigurdsson, G., Thorsson, A.V., Carroll, P.V., Korbonits, M., Benediktsson, R., (2015). The epidemiology of pituitary adenomas in Iceland, 1955–2012: a nationwide population-based study. Eur. J. Endocrinol. 173, 655–664.
2. Arafah, B.M., Nasrallah, M.P.., 2001. Pituitary tumors: pathophysiology, clinical manifestations and management. Endocr. Relat. Cancer. 8, 287-305.
3. Azzalin, A., Appin, C.L., Schniederjan, M.J., Constantin, T., Ritchie, J.C., Veledar, E., Oyesiku, N.M., Ioachimescu, A.G., 2016. Comprehensive evaluation of thyrotropinomas: single-center 20-year experience. Pituitary. 19, 183-193.
4. Berinder, K., Stackenäs, I., Akre, O., Hirschberg, A.L., Hulting, A.L., 2005. Hyperprolactinaemia in 271 Women: Up to Three Decades of Clinical Follow-Up. Clin Endocrinol. 63, 450-455.
5. Buchfelder, M., Schlaffer, S.M., 2017. The surgical treatment of acromegaly. Pituitary. 20, 76-83.
6. Burke, W.T. , Penn, D.L. , Castlen, J.P., Donoho, D.A., Repetti, C.S., Iuliano, S., Barkhoudarian, G. , Laws. E.R., 2019. Prolactinomas and nonfunctioning adenomas: preoperative diagnosis of tumor type using serum prolactin and tumor size. J. Neurosurg. 14, 1-8.
7. Chanson, P., Maiter, D., 2019. The Epidemiology, Diagnosis and Treatment of Prolactinomas: The Old and the New. Best. Pract.Res Clin. Endocrinol. Metab. 33, 101290.
8. Day, P.F., Guitelman, M., Artese, R., Fiszledjer, L., Chervin, A., Vitale, N.M., Stalldecker, G., De Miguel, V., Cornaló, D., Alfieri, A., Susana, M., Gil, M., 2004. Retrospective Multicentric Study of Pituitary Incidentalomas. Pituitary. 7, 145-148.

9. Dekkers, O.M., Pereira, A.M., Roelfsema, F., Voormolen, J.H., Neelis, K.J., Schroijen, M.A., Smit, J.W., Romijn, J.A., 2006. Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J. Clin. Endocrinol. Metab. 91, 1796–1801.
10. Dekkers, O.M., Pereira, A.M., Romijn, J.A., 2008. Treatment and Follow-Up of Clinically Nonfunctioning Pituitary Macroadenomas. J. Clin. Endocrinol. Metab. 93, 3717–3726.
11. Ezzat, S., Asa, S.L., Couldwell, W.T., Barr, C.E., Dodge, W.E., Vance, M.L., McCutcheon, I.E., 2004. The prevalence of pituitary adenomas: a systematic review. Cancer. 101, 613–619.
12. Feelders, R.A., Newell-Price, J., Pivonello, R., Nieman, L.K., Hofland, L.J., Lacroix, A., 2019. Advances in the medical treatment of Cushing’s syndrome. Lancet. Diabetes. Endocrinol. 7, 300-312.
13. Fernandez, A., Karavitaki, N., Wass, J.A., 2010. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin. Endocrinol. 72, 377-382.
14. Fontana, E., Gaillard, R., 2009. Epidemiology of pituitary adenoma: results of the first Swiss study. Rev. Med. Suisse. 5, 2172–2174.
15. Gruppetta, M., Merciera, C., Vassallo, J., 2013. Prevalence and incidence of pituitary adenomas: a population based study in Malta. Pituitary. 16, 545–553.
16. Gsponer, J., De Tribolet, N., Déruaz, J.P., Janzer, R., Uské, A., Mirimanoff, R.O., Reymond, M.J., Rey, F., Temler, E., Gaillard, R.C., Gomez, F., 1999. Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine (Baltimore). 78, 236-269.
17. Kim, J.H., Hur, K.Y., Lee, J.H., Lee, J.H., Se, Y.B., Kim, H.I., Lee, S.H, Nam, D.H., Kim, S.Y., Kim, K.W., Kong, D.S., Kim, Y.H., 2017. Outcome of endoscopic transsphenoidal surgery for acromegaly. World. Neurosurg. 104, 272-278.
18. Melmed, S., Casanueva, F.F., Hoffman, A.R., Kleinberg, D.L., Montori, V.M., Schlechte. J.A., Wass, J.A.H., Endocrine Society., 2011. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 273-288.
19. Melmed, S., 2020. Pituitary-Tumor Endocrinopathies. N. Engl. J. Med. 382, 937-950.
20. Nieman, L.K., Biller, B.M., Findling, J.W., Murad, M.H., Newell-Price, J., Savage, M.O., Tabarin, A., Endocrine Society., 2015. Treatment of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 100, 2807-2831.
21. Ntali, G., Wass, J.A., 2018. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas Pituitary. 21, 111–118.
22. Saeger, W., Lüdecke, DK.,. Buchfelder, M., Fahlbusch, R., Quabbe, H.J., Petersenn, S., 2007. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur. J. Endocrinol. 156, 203-216.
23. Sanno, N., Teramoto, A., Osamura, R.Y., 2001. Tyhrotropin-secreting pituitary adenomas. Clinical and biological heterogeneity and current treatment. J, Neurooncol. 54, 179-186.