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The Pituitary Gland

The Pituitary Gland

The pituitary is a small endocrine organ in the sphenoid bone under the hypothalamus. Primarily, the pituitary in adults has two distinct anatomical and functional regions— the anterior and posterior lobes. During human fetal development, a third pituitary gland region called the pars intermedia atrophies and disappears. However, some of its cells migrate and exist adjacent to the anterior pituitary in adults.

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Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...

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Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...

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A Novel Method: Super-selective Adrenal Venous Sampling

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Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary

Athanasios Fountas^1,2,3, Kirstie Lithgow^1,2,3, Paul Benjamin Loughrey^4,5

¹Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, IBR Tower, Level 2, Birmingham B15 2TT, United Kingdom.

European Journal of Endocrinology

|April 30, 2025

Summary

Surveillance of asymptomatic non-functioning pituitary macroadenomas (macroNFPAs) can be less frequent for tumors not near the optic chiasm. New pituitary hormone deficits are rare in stable macroNFPAs, questioning the need for regular function tests.

Keywords:

PitNET adenoma growth non-functioning pituitary

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Published on: April 2, 2018

Area of Science:

Endocrinology
Neurosurgery
Oncology

Background:

Asymptomatic non-functioning pituitary macroadenomas (macroNFPAs) are often monitored, but evidence for optimal surveillance frequency and surgical indications is limited.
Uncertainty exists regarding the best approach for managing macroNFPAs, impacting patient care and resource allocation.

Purpose of the Study:

To assess the natural history and outcomes of patients with macroNFPAs managed initially with monitoring.
To provide evidence-based recommendations for surveillance protocols and surgical indications in macroNFPAs.

Main Methods:

A multicentre, retrospective cohort study analyzed data from 949 patients across 21 UK endocrine departments between 2005 and 2022.
Clinical, imaging, and hormonal data were collected and analyzed to evaluate tumor behavior and patient outcomes.

Main Results:

Tumor enlargement occurred at a rate of 9.8 per 100 patient-years, with higher incidence in tumors near the optic chiasm.
For macroNFPAs not in contact with the optic chiasm, initial enlargement did not impact visual fields; 60.5% of enlarged tumors continued to grow during monitoring.
New pituitary hormone deficits occurred in 4.0%-4.9% of patients, primarily due to tumor enlargement, while surgical intervention showed limited rates of hypopituitarism reversal.

Conclusions:

Less frequent imaging is recommended for macroNFPAs not in contact with the optic chiasm, with the first follow-up scan potentially delayed to one year.
Tumor behavior after initial enlargement is variable, and new hypopituitarism in stable tumors is rare, suggesting a re-evaluation of regular pituitary function assessments.
The findings support refined monitoring protocols for macroNFPAs, optimizing surveillance strategies and potentially reducing unnecessary interventions.