[Management of patients with non-functioning pituitary adenomas. Summary of results of an expert conference of the Hypophysis Work Group of the German Society of Endocrinology, Friedewald, 15-17 February 2002].
BACKGROUND
Pituitary adenomas without clinically active hypersecretion are summarized under the term non-functioning pituitary adenomas (NFPA). Since there are no specific serum markers, the differential diagnosis and treatment imply special difficulties. Therefore, an expert group of the German Society of Endocrinology met in February 2002 and worked out concise practical management solutions.


METHODS
The diagnosis is initiated by magnetic resonance imaging (MRI) as in pituitary incidentalomas, or by mass effects with loss of pituitary function, mild hyperprolactinemia, or by neurologic and/or ophthalmologic symptoms. Except for null-cell adenomas and oncocytomas, different hormones, mainly gonadotropins, are found by immunohistology.


METHODS
No reliable medical tumor therapy of NFPA could be established. Small tumors need yearly follow-up by MRI, endocrine, and ophthalmologic assessment. The effectiveness of transnasal selective microsurgery in > 90% has been proven. With improvements of surgical facilities like better visualization, transcranial surgeries are rarely necessary. Surgery and endocrine management have to be under control of experienced specialists, and will be described in detail within the direct perioperative period and the necessary long-term followup. Large immediate or later mostly slowly regrowing tumor rests may be treated again by surgery or special radiotherapy.
Lüdecke
Dieter K
DK
Hypophysenchirurgie, Neurochirurgische Klinik, Universitäts-Krankenhaus Eppendorf, Hamburg. ludecke-dk@uke.uni-hamburg.de
D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003937:Diagnosis, Differential; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011182:Postoperative Care; D015175:Prolactinoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011879:Radiotherapy Dosage; D012737:Sex Factors; D009626:Terminology as Topic; D013997:Time Factors; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology