[Clinical analysis of large and/or invasive pituitary adenomas]

To establish a more reasonable therapeutic guide line for large and/or invasive pituitary adenomas, 257 cases of pituitary adenoma were analyzed. Among 83 cases with slight or moderate suprasellar extension (Wilson's Grade II-A & B) in the pre-CT era, 57 patients were alive at the time of follow-up (mean follow-up period: 12.7 years). Death of unspecified causes other than cancer, myocardial infarction, etc. were reported in nine patients. Among 60 cases of Grade II-A & B in the post-CT era, 59 patients were alive (mean follow-up: 3.4 years). Comparing these groups, cases with huge suprasellar extension (Grade C) had much worse prognosis. Only two patients were alive among 14 cases of Group C in the pre-CT era. Seven cases of death with unspecified causes were reported. In the 13 cases of Group C in the post-CT era, 12 patients were alive but at least four of them were severely handicapped. In 10 cases with sphenoid invasion (Grade IV) in the pre-CT era, only two were alive. In the group of Grade IV in the post-CT era, one patient died and three patients were operated repeatedly. Severe complications of irradiation therapy occurred in seven patients (mean interval: 6.6 years) among 120 cases of irradiated pituitary adenomas in every category. Among six cases with histological malignancy, three were operated repeatedly; among the latter group, two patients died and the third showed intracranial metastases. The present data indicate that large and/or invasive pituitary adenomas have a pessimistic prognosis, although adenomas with mild or moderate simple suprasellar extension have fairly good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)