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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Pituitary tumours: pituitary incidentalomas
1Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 530, Chicago, IL 60611, USA. molitch@northwestern.edu
Best Practice & Research. Clinical Endocrinology & Metabolism
|December 1, 2009
Summary
Clinically non-functioning pituitary adenomas, often found incidentally, require screening for hormonal imbalances and vision problems. Growth of these pituitary tumors necessitates surgical intervention.
Area of Science:
- Endocrinology
- Neurosurgery
- Radiology
Background:
- Clinically non-functioning pituitary adenomas present a spectrum from asymptomatic incidental findings to symptomatic masses causing dysfunction.
- Pituitary incidentalomas are frequently discovered during imaging for unrelated conditions.
Purpose of the Study:
- To outline the diagnostic and management strategies for clinically non-functioning pituitary adenomas and pituitary incidentalomas.
- To define screening protocols for hormonal hypersecretion, hypopituitarism, and visual field defects.
Main Methods:
- Review of clinical presentation and diagnostic criteria for non-functioning pituitary adenomas.
- Guidelines for screening hormonal hypersecretion (prolactin, IGF-1, cortisol) and hypopituitarism.
- Assessment of indications for surgical intervention based on tumor growth and mass effect.
Main Results:
- Approximately 10% of microadenomas and 24% of macroadenomas exhibit growth without treatment.
- Screening for hypersecretion is recommended for all pituitary incidentalomas.
- Macroadenomas require screening for hypopituitarism and visual field defects if impinging on the optic chiasm.
Conclusions:
- Non-functioning pituitary adenomas require tailored screening based on size and potential for mass effect.
- Monitoring via MRI is appropriate for asymptomatic cases without hormonal dysfunction or visual compromise.
- Tumor growth in pituitary incidentalomas is a definitive indication for surgical management.
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