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Physiopathology, Diagnosis, and Treatment of Nonfunctioning Pituitary Adenomas

  • Philippe Chanson
  • Anne-Lise Lecoq
  • Gerald Raverot
  • Frédéric Castinetti
  • Christine Cortet-Rudelli
  • Françoise Galland
  • Sylvie Salenave
Reference work entry
Part of the Endocrinology book series (ENDOCR)

Abstract

Clinically nonfunctioning pituitary adenomas (NFPAs) include all pituitary adenomas that are not hormonally active and are therefore not associated with clinical syndromes such as amenorrhea-galactorrhea (prolactinomas), acromegaly, Cushing’s disease, or hyperthyroidism (TSH-secreting adenomas). However, most such NFPAs in fact secrete gonadotropins or are actually gonadotroph pituitary adenomas. No univocal pathophysiological mechanism has been demonstrated. NFPA is usually diagnosed in a patient with signs and symptoms related to a mass effect (headache, visual impairment, sometimes pituitary apoplexy). More and more NFPAs are discovered incidentally. Biochemical workup often documents several pituitary insufficiencies. Unless contraindicated or in particular situations (e.g., incidentalomas at distance from optic pathways), surgery is the mainstay of treatment. Resection, generally via a transsphenoidal approach (with the help of an endoscope), should be performed by a neurosurgeon with extensive experience in pituitary surgery, in order to maximize the chances of complete resection and to minimize complications. If a tumor remnant persists (a frequent situation in patients with large and often invasive adenomas), watchful waiting is preferred to routine radiotherapy, as long as the tumor residue does not grow. NFPA can sometimes recur even after complete resection. Postoperative irradiation is only considered in case of residual tumor growth or relapse.

Keywords

Nonfunctioning pituitary adenomas Pituitary incidentalomas Neurosurgery Radiotherapy Gonadotroph adenomas Mass effect 

Notes

Acknowledgments

French Endocrinology Society Nonfunctioning Pituitary Adenoma Working Group Members.

Philippe Chanson (Paris-Kremlin-Bicêtre), Gérald Raverot (Lyon), Christine Cortet-Rudelli (Lille), Françoise Galland (Rennes), Fréderic Castinetti (Marseille), Sylvie Salenave (Paris-Kremlin-Bicêtre), Laure Cazabat (Boulogne-Billancourt), Luc Foubert (Suresnes), Jean-François Bonneville (Besançon), Stephan Gaillard (Suresnes), Anne Boulin (Suresnes), Emmanuel Sonnet (Brest), Marie-Christine Vantyghem (Lille), Guillaume Assie (Paris), Vincent Rohmer (Angers), Brigitte Delemer (Rennes), Jean-Louis Sadoul (Nice), Isabelle Raingeard (Montpellier), Jacqueline Trouillas (Lyon), Chiara Villa (Paris), Jean-Marc Kuhn (Rouen), Henry Dufour (Marseille), Anne Barlier (Marseille), Lorraine Clavier (Créteil), Rachel Desailloud (Amiens), Emmanuel Jouanneau (Lyon), Dominique Maiter (Bruxelles, Belgique), Catherine Massart (Rennes), Françoise Borson-Chazot (Lyon), Michèle D’herbomez (Lille), Bruno Estour (Saint-Etienne), Gilles Brassier (Rennes) Muriel Cogne (Saint-Denis, La Réunion), François Cotton (Lyon), Maud Lebas (Rouen), Lucie Abouaf (Lyon), Alain Vighetto (Lyon), Bernard Coche Dequéant (Lille), Patrick Toussaint (Amiens), Gwenaëlle Vidal-Trécan (Paris), Alexandre Vasiljevic (Lyon), and Hervé Lefebvre (Rouen).

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Philippe Chanson
    • 1
    • 2
    • 3
  • Anne-Lise Lecoq
    • 1
    • 2
    • 3
  • Gerald Raverot
    • 4
    • 5
  • Frédéric Castinetti
    • 6
  • Christine Cortet-Rudelli
    • 7
  • Françoise Galland
    • 8
  • Sylvie Salenave
    • 1
  1. 1.Service d’Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Hypophysaires RaresHôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de ParisLe Kremlin BicêtreFrance
  2. 2.Faculté de Médecine Paris-SudUniv Paris-Sud, UMR S1185Le Kremlin-BicêtreFrance
  3. 3.INSERM U1185Le Kremlin-BicêtreFrance
  4. 4.Fédération d’Endocrinologie, Groupement Hospitalier EstHospices Civils de LyonLyonFrance
  5. 5.INSERM U1028; CNRS UMR5292; Centre de Recherche Lyon Neuroscience, Université de LyonLyonFrance
  6. 6.Service d’EndocrinologieUniversité Aix Marseille, Hôpital de la ConceptionMarseilleFrance
  7. 7.Service d’Endocrinologie-MétabolismeCentre Hospitalier et Universitaire de LilleLilleFrance
  8. 8.Service d’Endocrinologie, Diabétologie, Nutrition, CHU RennesHôpital SudRennesFrance

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