Nonfunctioning Pituitary Adenoma: Management
Since nonfunctioning pituitary adenomas do not present with a clinical syndrome of pituitary hormone excess, common presentations include neurologic symptoms such as visual impairment and/or headache, symptoms of pituitary hormone deficiency, or an incidental sellar mass on an imaging study. The evaluation of a newly diagnosed pituitary adenoma should include a detailed history and physical exam, a dedicated pituitary MRI, biochemical evaluation of pituitary hormone excess and deficiency, and visual field and acuity testing if clinically indicated. Vision impairment due to optic chiasm compression is a clear indication for transsphenoidal surgery. Transsphenoidal surgery may also be considered in cases of high risk of visual impairment, clinically significant tumor growth, and/or hypopituitarism. Transsphenoidal surgery is typically successful in reducing tumor volume and improving vision and is less successful in reversing hypopituitarism. If there is little or no residual adenoma on pituitary MRI, the patient should still be monitored for recurrence with serial pituitary MRI scans. If there is significant residual adenoma on pituitary MRI or progressive adenoma regrowth after surgery, postoperative radiation therapy may be considered.
KeywordsNonfunctioning pituitary adenoma Bitemporal hemianopsia Transsphenoidal surgery Hypopituitarism
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