{"id":4422286,"date":"2025-01-11T11:57:39","date_gmt":"2025-01-11T17:57:39","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/nonfunctioning-pituitary-adenoma\/"},"modified":"2025-01-13T06:50:26","modified_gmt":"2025-01-13T12:50:26","slug":"nonfunctioning-pituitary-adenoma","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/nonfunctioning-pituitary-adenoma\/","title":{"rendered":"Nonfunctioning Pituitary Adenoma"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">CLINICALLY NONFUNCTIONING PITUITARY TUMOR<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Definition and Overview<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Clinically Nonfunctioning Pituitary Tumors<\/strong>\n<ul class=\"wp-block-list\">\n<li>Identified incidentally on head MRI or due to sellar mass\u2013related symptoms (e.g., visual field defect).<\/li>\n\n\n\n<li>Pituitary <strong>microadenomas<\/strong> (\u226410 mm) are relatively common (found in ~11% of pituitary glands on autopsy), but <strong>macroadenomas<\/strong> (>10 mm) are much less common.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Histopathology and Origin<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Gonadotroph Cell Adenoma<\/strong>\n<ul class=\"wp-block-list\">\n<li>Most frequent type of clinically nonfunctioning pituitary macroadenoma.<\/li>\n\n\n\n<li>Usually do not hypersecrete gonadotropins (no hormone-excess syndrome).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Null Cell (Chromophobe) Adenoma<\/strong>\n<ul class=\"wp-block-list\">\n<li>Second most common nonfunctioning macroadenoma.<\/li>\n\n\n\n<li>Benign neoplasm of adenohypophyseal cells staining negative for all anterior pituitary hormones on immunohistochemistry.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Rare Silent Adenomas<\/strong>\n<ul class=\"wp-block-list\">\n<li>Lactotroph, somatotroph, or corticotroph adenomas can be clinically silent (i.e., not producing symptoms of hormone excess).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">CLINICAL PRESENTATION<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Mass-Effect Symptoms of Pituitary Macroadenomas<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Visual Field Defects<\/strong>\n<ul class=\"wp-block-list\">\n<li>Suprasellar extension \u2192 compression of the optic chiasm.<\/li>\n\n\n\n<li>Gradual onset of superior bitemporal quadrantopia \u2192 can progress to bitemporal hemianopsia.<\/li>\n\n\n\n<li>Vision loss may go unnoticed until it becomes significant.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Diplopia<\/strong>\n<ul class=\"wp-block-list\">\n<li>Extension into the cavernous sinus compresses <a href=\"https:\/\/myendoconsult.com\/learn\/mnemonic-cranial-nerves-dirty-surprise\/\"  data-wpil-monitor-id=\"71\">cranial nerves<\/a> controlling eye movements.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Pituitary Insufficiency<\/strong>\n<ul class=\"wp-block-list\">\n<li>Compression of normal pituitary gland tissue, leading to hypopituitarism.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Headaches<\/strong>\n<ul class=\"wp-block-list\">\n<li>Related to tumor expansion in the sellar region.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">DIAGNOSIS AND EVALUATION<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>MRI<\/strong>\n<ul class=\"wp-block-list\">\n<li>Imaging modality of choice to evaluate the sella and surrounding structures.<\/li>\n\n\n\n<li>Shows the extent of suprasellar and parasellar extension of the macroadenoma.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Hormonal Assessment<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Hyperprolactinemia<\/strong> (mild, typically 30\u2013200 ng\/mL) may be due to stalk compression inhibiting dopaminergic (prolactin-inhibitory) control of lactotrophs.<\/li>\n\n\n\n<li><strong>Other Pituitary Hormones to Measure<\/strong> in all patients with macroadenomas:\n<ul class=\"wp-block-list\">\n<li>Luteinizing hormone (LH)<\/li>\n\n\n\n<li>Follicle-stimulating hormone (FSH)<\/li>\n\n\n\n<li>\u03b1-Subunit of glycoprotein hormones<\/li>\n\n\n\n<li>Gonadal hormones (estrogen in women, testosterone in men)<\/li>\n\n\n\n<li>Insulin-like growth factor 1 (IGF-1)<\/li>\n\n\n\n<li>Corticotropin (ACTH) and cortisol<\/li>\n\n\n\n<li>Thyrotropin (TSH) and free thyroxine (T4)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/myendoconsult.com\/learn\/diabetes-insipidus\/\"  data-wpil-monitor-id=\"72\">Diabetes Insipidus<\/a><\/strong> is rare with benign adenohypophyseal tumors.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Visual Field Examination<\/strong>\n<ul class=\"wp-block-list\">\n<li>Assess for bitemporal hemianopsia or other defects if the tumor is large or close to the optic chiasm.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">TREATMENT<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Goals<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Relieve Mass-Effect Symptoms<\/strong> (e.g., vision loss).<\/li>\n\n\n\n<li><strong>Preserve Pituitary Function<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Management Options<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Observation<\/strong>\n<ul class=\"wp-block-list\">\n<li>Reasonable for elderly patients with normal visual fields and small or stable tumors.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Transsphenoidal Surgery<\/strong>\n<ul class=\"wp-block-list\">\n<li>Recommended for patients with vision loss or progressive tumor growth.<\/li>\n\n\n\n<li>Can provide prompt resolution of visual field defects and potentially cure the tumor.<\/li>\n\n\n\n<li>Some patients experience recovery of preoperative pituitary insufficiency post-surgery.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Radiotherapy (e.g., Stereotactic Gamma Knife)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Considered if the adenoma recurs after transsphenoidal surgery or if surgery is incomplete.<\/li>\n\n\n\n<li>Postoperative MRI is typically performed ~3 months after surgery to assess resection extent and tumor status.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">POSTOPERATIVE FOLLOW-UP<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>MRI Surveillance<\/strong>\n<ul class=\"wp-block-list\">\n<li>Usually repeated 3 months after surgery, then periodically to detect early recurrence.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Hormone Levels<\/strong>\n<ul class=\"wp-block-list\">\n<li>Check any previously elevated tumor markers (e.g., \u03b1-subunit) or other hormone abnormalities.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Long-Term Management<\/strong>\n<ul class=\"wp-block-list\">\n<li>Recurrence can be treated with further surgery or stereotactic radiotherapy.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>CLINICALLY NONFUNCTIONING PITUITARY TUMOR Definition and Overview Histopathology and Origin CLINICAL PRESENTATION Mass-Effect Symptoms of Pituitary Macroadenomas DIAGNOSIS AND EVALUATION TREATMENT Goals Management Options POSTOPERATIVE FOLLOW-UP<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[682],"class_list":["post-4422286","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-pituitary-gland","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422286","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":3,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422286\/revisions"}],"predecessor-version":[{"id":4422290,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422286\/revisions\/4422290"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422286"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}