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Radiologic follow-up of non-functioning pituitary adenomas: rationale and cost effectiveness

  • Clinical Study - Patient Studies
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Abstract

Patients with non-functioning pituitary adenomas (NFPAs) are followed-up with serial endocrine, ophthalmologic and radiological assessment. There is a lack of evidence based guidance regarding the frequency and duration of radiological assessment during follow-up. We retrospectively analysed the details of follow-up radiological scanning in a cohort of patients diagnosed with NFPAs in an attempt to devise a rational and cost effective scanning schedule for use in routine clinical practice. 49 patients were identified using the hospital endocrine register. A detailed review of the case notes and follow up scans was undertaken. The data was analysed using descriptive statistics and Kaplan–Meier survival analysis using SPSS ver 13.0 (SPSS Inc. Chicago, IL). The time in which the tumor size in the followed up patients reached a state of ‘no change’ which persisted for at least two further scans was calculated. 41 patients, followed up for a median duration of 70 months were ultimately analysed. 33 patients had surgery while eight were conservatively managed. The time taken by 50% of tumors to achieve a steady state of ‘no change’ in tumor size on scans was 30 months. 90% of tumours achieved this state in 88 months. Surgical management did not significantly influence the time required to attain the steady state on a Kaplan–Meier analysis (Log rank test P = 0.06). NFPAs need extended follow-up since late recurrences after treatment are known. Routine radiologic follow up may be uneconomical after the steady state is achieved. Regular Goldmann perimetry beyond this time may be of greater use in selecting patients who actually need repeat surgical debulking. This method of follow up is likely to be more cost effective and reduce the number of scans performed.

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References

  1. Jaffe CA (2006) Clinically non-functioning pituitary adenoma. Pituitary 9:317–321. doi:10.1007/s11102-006-0412-9

    Article  PubMed  Google Scholar 

  2. Jane JA Jr, Laws ER Jr (2002) Surgical management of pituitary adenomas. Singapore Med J 43:318–323

    PubMed  Google Scholar 

  3. McComb DJ, Ryan N, Horvath E, Kovacs K (1983) Subclinical adenomas of the human pituitary. New light on old problems. Arch Pathol Lab Med 107:488–491

    PubMed  CAS  Google Scholar 

  4. Harris PE, Afshar F, Coates P et al (1989) The effects of transsphenoidal surgery on endocrine function and visual fields in patients with functionless pituitary tumours. Q J Med 71:417–427

    PubMed  CAS  Google Scholar 

  5. Dekkers OM, Hammer S, de Keizer RJ et al (2007) The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol 156:217–224. doi:10.1530/eje.1.02334

    Article  PubMed  CAS  Google Scholar 

  6. Dekkers OM, Pereira AM, Roelfsema F et al (2006) Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab 91:1796–1801. doi:10.1210/jc.2005-2552

    Article  PubMed  CAS  Google Scholar 

  7. Lohmann T, Trantakis C, Biesold M et al (2001) Minor tumour shrinkage in nonfunctioning pituitary adenomas by long-term treatment with the dopamine agonist cabergoline. Pituitary 4:173–178. doi:10.1023/A:1015366923810

    Article  PubMed  CAS  Google Scholar 

  8. Hayashi M, Izawa M, Hiyama H et al (1999) Gamma Knife radiosurgery for pituitary adenomas. Stereotact Funct Neurosurg 72(Suppl 1):111–118. doi:10.1159/000056446

    Article  PubMed  Google Scholar 

  9. Muacevic A, Uhl E, Wowra B (2004) Gamma knife radiosurgery for nonfunctioning pituitary adenomas. Acta Neurochir Suppl (Wien) 91:51–54

    CAS  Google Scholar 

  10. Brada M, Rajan B, Traish D et al (1993) The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf) 38:571–578. doi:10.1111/j.1365-2265.1993.tb02137.x

    Article  CAS  Google Scholar 

  11. Bradley KM, Adams CB, Potter CP et al (1994) An audit of selected patients with non-functioning pituitary adenoma treated by transsphenoidal surgery without irradiation. Clin Endocrinol (Oxf) 41:655–659. doi:10.1111/j.1365-2265.1994.tb01832.x

    Article  CAS  Google Scholar 

  12. Breen P, Flickinger JC, Kondziolka D, Martinez AJ (1998) Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumor control. J Neurosurg 89:933–938

    Article  PubMed  CAS  Google Scholar 

  13. Sanno N, Oyama K, Tahara S, Teramoto A, Kato Y (2003) A survey of pituitary incidentaloma in Japan. Eur J Endocrinol 149:123–127. doi:10.1530/eje.0.1490123

    Article  PubMed  CAS  Google Scholar 

  14. Soto-Ares G, Cortet-Rudelli C, Assaker R et al (2002) MRI protocol technique in the optimal therapeutic strategy of non-functioning pituitary adenomas. Eur J Endocrinol 146:179–186. doi:10.1530/eje.0.1460179

    Article  PubMed  CAS  Google Scholar 

  15. Turner HE, Stratton IM, Byrne JV, Adams CB, Wass JA (1999) Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation––a follow-up study. Clin Endocrinol (Oxf) 51:281–284. doi:10.1046/j.1365-2265.1999.00865.x

    Article  CAS  Google Scholar 

  16. Ferrante E, Ferraroni M, Castrignano T et al (2006) Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol 155:823–829. doi:10.1530/eje.1.02298

    Article  PubMed  CAS  Google Scholar 

  17. Ciric I, Mikhael M, Stafford T, Lawson L, Garces R (1983) Transsphenoidal microsurgery of pituitary macroadenomas with long-term follow-up results. J Neurosurg 59:395–401

    Article  PubMed  CAS  Google Scholar 

  18. Flickinger JC, Nelson PB, Martinez AJ, Deutsch M, Taylor F (1989) Radiotherapy of nonfunctional adenomas of the pituitary gland. Results with long-term follow-up. Cancer 63:2409–2414. doi:10.1002/1097-0142(19890615)63:12>2409::AID-CNCR2820631206>3.0.CO;2-M

    Article  PubMed  CAS  Google Scholar 

  19. Grigsby PW, Simpson JR, Emami BN, Fineberg BB, Schwartz HG (1989) Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys 16:1411–1417

    PubMed  CAS  Google Scholar 

  20. Park P, Chandler WF, Barkan AL et al (2004) The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery 55:100–106. doi:10.1227/01.NEU.0000126885.71242.D7 discussion 106-107

    Article  PubMed  Google Scholar 

  21. Woollons AC, Hunn MK, Rajapakse YR et al (2000) Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf) 53:713–717. doi:10.1046/j.1365-2265.2000.01153.x

    Article  CAS  Google Scholar 

  22. Greenman Y, Ouaknine G, Veshchev I et al (2003) Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 58:763–769. doi:10.1046/j.1365-2265.2003.01784.x

    Article  CAS  Google Scholar 

  23. Lillehei KO, Kirschman DL, Kleinschmidt-DeMasters BK, Ridgway EC (1998) Reassessment of the role of radiation therapy in the treatment of endocrine-inactive pituitary macroadenomas. Neurosurgery 43:432–438. doi:10.1097/00006123-199809000-00020 discussion 438–439

    Article  PubMed  CAS  Google Scholar 

  24. Donovan LE, Corenblum B (1995) The natural history of the pituitary incidentaloma. Arch Intern Med 155:181–183. doi:10.1001/archinte.155.2.181

    Article  PubMed  CAS  Google Scholar 

  25. Reincke M, Allolio B, Saeger W, Menzel J, Winkelmann W (1990) The ‘incidentaloma’ of the pituitary gland. Is neurosurgery required? JAMA 263:2772–2776. doi:10.1001/jama.263.20.2772

    Article  PubMed  CAS  Google Scholar 

  26. Alameda C, Lucas T, Pineda E et al (2005) Experience in management of 51 non-functioning pituitary adenomas: indications for post-operative radiotherapy. J Endocrinol Invest 28:18–22

    PubMed  CAS  Google Scholar 

  27. Grigsby PW, Simpson JR, Fineberg B (1989) Late regrowth of pituitary adenomas after irradiation and/or surgery. Hazard function analysis. Cancer 63:1308–1312. doi:10.1002/1097-0142(19890401)63:7<1308::AID-CNCR2820630714>3.0.CO;2-Y

    Article  PubMed  CAS  Google Scholar 

  28. Popovic V, Damjanovic S, Micic D et al (1998) Increased incidence of neoplasia in patients with pituitary adenomas. The Pituitary Study Group. Clin Endocrinol (Oxf) 49:441–445. doi:10.1046/j.1365-2265.1998.00536.x

    Article  CAS  Google Scholar 

  29. Feldkamp J, Santen R, Harms E et al (1999) Incidentally discovered pituitary lesions: high frequency of macroadenomas and hormone-secreting adenomas––results of a prospective study. Clin Endocrinol (Oxf) 51:109–113. doi:10.1046/j.1365-2265.1999.00748.x

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Medical School, University of Newcastle Upon Tyne, Newcastle, UK

    Ian C. Coulter

  2. Department of Neurosurgery, James Cook University Hospital, Middlesbrough, TS4 3BW, UK

    Nitin Mukerji & Philip J. Kane

  3. Department of Neuroradiology, James Cook University Hospital, Middlesbrough, UK

    Nicholas Bradey

  4. Department of Endocrinology, James Cook University Hospital, Middlesbrough, UK

    Vincent Connolly

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  1. Ian C. Coulter
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  2. Nitin Mukerji
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  3. Nicholas Bradey
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  4. Vincent Connolly
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  5. Philip J. Kane
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Correspondence to Philip J. Kane.

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Coulter, I.C., Mukerji, N., Bradey, N. et al. Radiologic follow-up of non-functioning pituitary adenomas: rationale and cost effectiveness. J Neurooncol 93, 157–163 (2009). https://doi.org/10.1007/s11060-009-9901-9

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  • DOI: https://doi.org/10.1007/s11060-009-9901-9

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