title: Non-functioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic.
abstract: OBJECTIVE
  Pituitary incidentalomas (PIs) constitute an increasingly clinical problem. While the therapeutic management is well defined for symptomatic non-functioning PIs (NFPIs), a controversy still exists for asymptomatic macro-NFPIs between surgery and a "wait and see" approach. The aim of this study is to compare surgical results between symptomatic and asymptomatic macro-NFPIs.
  
  
  METHODS
  We conducted a retrospective study on 76 patients with newly diagnosed symptomatic and asymptomatic macro-NFPIs operated on between 2001 and 2010. We compared age, tumor size and surgical results between these two patient groups.
  
  
  RESULTS
  After the initial evaluation, 48 patients were found to be symptomatic. Gross total removal (GTR) rate was significantly higher in asymptomatic (82%) than in symptomatic patients (58%; p=0.03). Gross total removal was strongly associated with Knosp's classification (p=0.01). Postoperative endocrinological impairment was significantly associated with the existence of preoperative symptoms (p=0.03). It was 10 times less frequent in the asymptomatic group. In symptomatic patients, postoperative visual and endocrinological impairment were present in 49% and 78% versus 0% and 14% in asymptomatic patients respectively.
  
  
  CONCLUSIONS
  The endocrinological and visual outcome was better in those patients who underwent surgery for asymptomatic tumors. The extent of tumor resection was also significantly greater in smaller tumors. It would therefore be appropriate to offer surgery to patients with asymptomatic macro-NFPIs.
authors.affiliation: Département de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland. Electronic address: m.messerer@laposte.net.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Messerer
authors.forename: Julie
authors.initials: J
authors.lastname: Dubourg
authors.forename: Gérald
authors.initials: G
authors.lastname: Raverot
authors.forename: David
authors.initials: D
authors.lastname: Bervini
authors.forename: Moncef
authors.initials: M
authors.lastname: Berhouma
authors.forename: Ipe
authors.initials: I
authors.lastname: George
authors.forename: Ari George
authors.initials: AG
authors.lastname: Chacko
authors.forename: Gilles
authors.initials: G
authors.lastname: Perrin
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.forename: Roy Thomas
authors.initials: RT
authors.lastname: Daniel
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Trouillas
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Jouanneau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D019635:Neurosurgical Procedures; D010901:Pituitary Function Tests; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014787:Vision Tests
keywords: Incidentalomas; Management; Non-functioning pituitary adenomas; Transsphenoidal surgery