Sporadic pituitary tumours: from epidemiology to use of databases

Pituitary tumours account for 10% of intracranial neoplasms and have an annual incidence of about 25 per million head of population. Prolactinomas and non-functioning tumours are the most common subtypes clinically, as well as in surgical and histopathological series. In pre-pubertal children, corticotrophinomas, although rare, are the most common subtype, prolactinomas being most common in adolescents. In autopsy series, 11% of pituitaries harbour an adenoma. These are usually small (less than 10 mm in diameter), and where examined, about half are prolactinomas. Computed tomography or magnetic resonance imaging examination of normal subjects reveals abnormalities of greater than 3 mm in diameter in 10% of pituitaries. Other cancers in patients with pituitary tumours are confined to acromegalics, in whom colonic lesions are more prevalent than in the general population. Several long-term sequelae of pituitary tumours with respect to morbidity and mortality have been identified from retrospective analyses. However, data on these are not standardized, requiring the development of national databases and registers to collect clinical outcomes from large cohorts according to agreed standard proformas. These registers will provide a sufficient number of cases for statistically valid conclusions on different clinical subgroups. The development of national guidelines for best practice for the management of patients with these tumours provides the basis for an audit of the management process and outcomes between centres. This will inform decisions on the optimum configuration of services for such patients.