Nonfunctioning Pituitary Adenoma: Management

  • Melanie SchorrEmail author


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.


Nonfunctioning pituitary adenoma Bitemporal hemianopsia Transsphenoidal surgery Hypopituitarism 


  1. 1.
    Jukich PJ, McCarthy BJ, Surawicz TS, Freels S, Davis FG. Trends in incidence of primary brain tumors in the United States, 1985-1994. Neuro-oncology. 2001;3(3):141–51.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Popovic V, Damjanovic S. The effect of thyrotropin-releasing hormone on gonadotropin and free alpha-subunit secretion in patients with acromegaly and functionless pituitary tumors. Thyroid. 1998;8(10):935–9. Scholar
  3. 3.
    Rajasekaran S, Vanderpump M, Baldeweg S, et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf). 2011;74(1):9–20. Scholar
  4. 4.
    Fatemi N, Dusick JR, Mattozo C, et al. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008;63(4):709–718; discussion 718–9. Scholar
  5. 5.
    Webb SM, Rigla M, Wägner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999;84(10):3696–700. Scholar
  6. 6.
    Marazuela M, Astigarraga B, Vicente A, et al. Recovery of visual and endocrine function following transsphenoidal surgery of large nonfunctioning pituitary adenomas. J Endocrinol Invest. 1994;17(9):703–7. Scholar
  7. 7.
    Dekkers OM, Pereira AM, Roelfsema F, et al. Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma. J Clin Endocrinol Metab. 2006;91(5):1796–801. Scholar
  8. 8.
    Molitch ME. Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin North Am. 2008;37(1):151–171, xi. Scholar
  9. 9.
    Freda PU, Beckers AM, Katznelson L, et al. Pituitary incidentaloma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(4):894–904. Scholar
  10. 10.
    Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am. 1999;28(1):81–117, vi.CrossRefPubMedGoogle Scholar
  11. 11.
    Karavitaki N, Thanabalasingham G, Shore HCA, et al. Do the limits of serum prolactin in disconnection hyperprolactinaemia need re-definition? A study of 226 patients with histologically verified non-functioning pituitary macroadenoma. Clin Endocrinol (Oxf). 2006;65(4):524–9. Scholar
  12. 12.
    Chen L, White WL, Spetzler RF, Xu B. A prospective study of nonfunctioning pituitary adenomas: presentation, management, and clinical outcome. J Neurooncol. 2011;102(1):129–38. Scholar
  13. 13.
    Dallapiazza RF, Grober Y, Starke RM, Laws ER, Jane JA. Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas. Neurosurgery. 2015;76(1):42–52; discussion 52–3. Scholar
  14. 14.
    Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery. 2005;56(6):1222–1233; discussion 1233.CrossRefPubMedGoogle Scholar
  15. 15.
    Murad MH, Fernández-Balsells MM, Barwise A, et al. Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clin Endocrinol (Oxf). 2010;73(6):777–91. Scholar
  16. 16.
    Woollons AC, Hunn MK, Rajapakse YR, et al. Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol. 2000;53(6):713–7. Scholar
  17. 17.
    Boelaert K, Gittoes NJ. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinol. 2001;144(6):569–75.CrossRefPubMedGoogle Scholar
  18. 18.
    Greenman Y, Cooper O, Yaish I, et al. Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists. Eur J Endocrinol. 2016;175(1):63–72. Scholar
  19. 19.
    Dekkers OM, Hammer S, de Keizer RJW, et al. The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol. 2007;156(2):217–24. Scholar
  20. 20.
    Arita K, Tominaga A, Sugiyama K, et al. Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination. J Neurosurg. 2006;104(6):884–91. Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neuroendocrine UnitMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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