Related Experiment Video
Updated: Aug 10, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Refractory nonfunctioning pituitary adenomas
Tamara Kolitz1, Yona Greenman2,3
1Institute of Endocrinology, Diabetes, Metabolism, and Hypertension, Tel Aviv-Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
Abstract:
Non-functioning pituitary adenomas (NFPAs) comprise silent tumors of different pituitary lineages that tend to escape early detection and present as invasive macroadenomas with symptoms of mass effect. Incomplete surgical resection is common and may be followed by significant rates of subsequent remnant progression. Pituitary tumors are defined as refractory when resistance to optimal standard therapies including surgery, radiotherapy, and medical treatment is documented. In the absence of approved medications for the treatment of NFPAs, the last criterion to classify these tumors as refractory is ill defined. Silent corticotroph and null cell adenomas have been reported, albeit not in all studies, to be larger and recur more often compared with silent gonadotroph tumors. Nevertheless, it is currently unknown if certain NFPA subtypes are more often refractory using well defined criteria. The response rate to temozolomide is lower in NFPA compared to that seen in functioning tumors. Refractory NFPAs present a significant diagnostic and therapeutic challenge and are associated with increased morbidity and mortality rates.
Insights
Non-functioning pituitary adenomas (NFPAs) are silent tumors often detected late. Refractory NFPAs pose diagnostic and therapeutic challenges, with limited treatment options and higher mortality risks.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Non-functioning pituitary adenomas (NFPAs) are silent tumors often presenting as invasive macroadenomas.
- Incomplete surgical resection is common, leading to significant rates of tumor remnant progression.
- Refractory pituitary tumors resist standard therapies, but criteria for refractory NFPAs are ill-defined.
Purpose of the Study:
- To investigate if specific non-functioning pituitary adenoma subtypes are more frequently refractory.
- To clarify diagnostic and therapeutic challenges associated with refractory NFPAs.
Main Methods:
- Review of literature on pituitary tumor subtypes and refractory characteristics.
- Analysis of reported response rates to therapies like temozolomide in NFPAs versus functioning tumors.
Main Results:
- Silent corticotroph and null cell adenomas may be larger and recur more often than silent gonadotroph tumors.
- Response rates to temozolomide are lower in NFPAs compared to functioning pituitary tumors.
- Refractory NFPAs are associated with increased morbidity and mortality.
Conclusions:
- The definition and identification of refractory NFPA subtypes require further investigation.
- Refractory NFPAs present significant clinical challenges due to limited effective treatments and poor outcomes.
Related Concept Videos
01:17The Pituitary Gland
01:27Hormones of the Pituitary Gland
The most abundantly secreted hormone from the anterior lobe is the growth hormone, which controls overall growth by...
01:22Adrenergic Antagonists: Pharmacological Actions of ɑ-Receptor Blockers
α1-blockers: These drugs inhibit α1-adrenoceptors on smooth muscle cells, resulting in vasodilation. This vasodilation lowers blood pressure, making α1-blockers valuable in treating hypertension. Additionally,...
01:30Spare Receptors
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...