title: Post-surgical management of non-functioning pituitary adenoma.
abstract: Post-surgical surveillance of non-functioning pituitary adenoma (NFPA) is based on magnetic resonance imaging (MRI) at 3 or 6 months then 1 year. When there is no adenomatous residue, annual surveillance is recommended for 5 years and then at 7, 10 and 15 years. In case of residue or doubtful MRI, prolonged annual surveillance monitors any progression. Reintervention is indicated if complete residue resection is feasible, or for symptomatic optic pathway compression, to create a safety margin between the tumor and the optic pathways ahead of complementary radiation therapy (RT), or in case of post-RT progression. In case of residue, unless the tumor displays elevated growth potential, it is usually recommended to postpone RT until progression is manifest, as efficacy is comparable whether treatment is immediate or postponed. The efficacy of the various RT techniques in terms of tumor volume control is likewise comparable. RT-induced hypopituitarism is frequent, whatever the technique. The choice thus depends basically on residue characteristics: size, delineation, and proximity to neighboring radiation-sensitive structures. Reduced rates of vascular complications and secondary brain tumor can be hoped for with one-dose or hypofractionated stereotactic RT, but there has been insufficient follow-up to provide evidence. Somatostatin analogs and dopaminergic agonists have yet to demonstrate sufficient efficacy. Temozolomide is an option in aggressive NFPA resistant to surgery and RT.
authors.affiliation: Service de diabétologie, d'endocrinologie et des maladies métaboliques, hôpital Huriez, CHU de Lille, 59037 Lille cedex, France. Electronic address: c.cortet@gmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Cortet-Rudelli
authors.affiliation: Service d'endocrinologie, CHU Sart Tilman, Liège, Belgium. Electronic address: bonnevillejf@gmail.com.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bonneville
authors.affiliation: Fédération d'endocrinologie, groupement hospitalier Est, hospices civils de Lyon, université Lyon 1, 69372 Lyon, France. Electronic address: francoise.borson-chazot@chu-lyon.fr.
authors.forename: Françoise
authors.initials: F
authors.lastname: Borson-Chazot
authors.affiliation: Unité d'endocrinologie-diabétologie-médecine interne, CHU Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94010 Créteil cedex, France. Electronic address: lorraine.clavier@hmn.aphp.fr.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Clavier
authors.affiliation: Service de radiothérapie, centre Oscar-Lambret, 59020 Lille cedex, France. Electronic address: b-cochedequeant@o-lambret.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Coche Dequéant
authors.affiliation: Service d'endocrinologie-diabétologie-nutrition, hôpital Sud, CHU d'Amiens, 80054 Amiens cedex 1, France. Electronic address: desailloud.rachel@chu-amiens.fr.
authors.forename: Rachel
authors.initials: R
authors.lastname: Desailloud
authors.affiliation: Service d'endocrinologie et de nutrition, cliniques universitaires Saint-Luc, 1200 Bruxelles, Belgium. Electronic address: dominique.maiter@uclouvain.be.
authors.forename: Dominique
authors.initials: D
authors.lastname: Maiter
authors.affiliation: Service d'endocrinologie, CHU d'Angers, LUNAM University, 49000 Angers, France. Electronic address: virohmer@chu-angers.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Rohmer
authors.affiliation: Service d'endocrinologie, hôpital de l'Archet, CHU de Nice, 06200 Nice, France. Electronic address: sadoul.jl@chu-nice.fr.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Sadoul
authors.affiliation: Service d'endocrinologie-diabétologie, hôpital Cavale-Blanche, CHU de Brest, 29609 Brest cedex, France. Electronic address: emmanuel.sonnet@chu-brest.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sonnet
authors.affiliation: Service de neurochirurgie, hôpital Sud, CHU d'Amiens, 80054 Amiens cedex 1, France. Electronic address: toussaint.patrick@chu-amiens.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Toussaint
authors.affiliation: Service d'endocrinologie et des maladies de la reproduction, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France; UMR S1185, faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; INSERM U1185, 94276 Le Kremlin-Bicêtre, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D011182:Postoperative Care / Q000379:methods*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods
keywords: Adénomes gonadotropes; Adénomes hypophysaires non fonctionnels; Adénomes hypophysaires non sécrétants; Adénomes hypophysaires silencieux; Chirurgie hypophysaire; Gonadotroph adenoma; Non-functioning pituitary adenoma; Non-secreting pituitary adenoma; Pituitary surgery; Radiation therapy; Radiothérapie; Silent pituitary adenoma