Non functional pituitary tumor

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Non Functional Pituitary Tumor

Clinical Features

  1. Present as large masses due to slow growth and frequent lack of hormonal side effects
  2. Visual disturbances are the most common initial complaint followed by headache and other increased ICP symptoms (Zhang et al. reported on 208 patients with NFPAs, (54 Hardy grades C and D) in which none had significant endocrinological disturbance)
  3. Several reports of NFPAs with significant suprasellar extension (Hardy D tumors – greater than 30mm of extension beyond the foramen of Monro) treated with combined transsphenoidal and craniotomy for tumor resection
  4. Common complications of surgery for these tumors include: Diabetes Insipidus, CSF leak, Hemorrhage in Tumor Cavity, Cavernous sinus damage
Sagittal T1 weighted MRI with contrast showing NFPA with suprasellar and intraventricular extension.

Treatment

  • Common methods used to coax the suprasellar component of the tumor downward include: Compression of IJ bilaterally, infusion of saline or air through a lumbar catheter, usually not sufficient for tumors with significant intracranial extension
  • Treatment of residual often involves stereotactic radiosurgery. Shown by several groups to be superior to fractionated radiation with fewer side effects and excellent local control rates (~90%)

References

  1. Zhang et al. Management of Nonfunctioning Pituitary Adenomas with Suprasellar Extensions by Transsphenoidal Microsurgery. Surg Neurol 1999,52:380-5
  2. Satio K et al. The Transsphenoidal Removal of Nonfunctioning Adenomas with Suprasellar Extensions: The Open Sellar Method and Intentionally Staged Operation. Neurosurgery 1995:36,668-76
  3. Yokoyama S et al. Are nonfunctioning pituitary adenomas extending into the cavernous sinus aggressive and/or invasive? Neurosurgery. 2001 Oct;49(4):857-62
  4. Losa M et al. Gamma knife surgery for treatment of residual nonfunctioning pituitary adenomas after surgical debulking. J Neurosurg. 2004 Mar;100(3):438-44
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