Incidental versus symptomatic nonfunctioning pituitary adenomas: Are they different?

Autores da FMUP

• Vanessa Alexandra Guerreiro Gonçalves

  Autor

• Fernando Miguel Da Silva Mendonça

  Autor

• Paula Isabel Marques Simões De Freitas

  Autor

• João Tiago De Sousa Pinto Guimarães

  Autor

• Davide Maurício Costa Carvalho

  Autor

Participantes de fora da FMUP

• Ferreira, HU
• Pereira, J
• Bernardes, I
• Pinheiro, J

Unidades de investigação

• Biomedicina

• Medicina

Abstract

Background Nonfunctioning pituitary adenomas (NFPAs) constitute one of the most common tumours in the sellar region and are often discovered only when associated with compressive symptoms. With the frequent use of brain imaging, there has been an increase in the prevalence of incidentally discovered NFPAs.Aim We aim to determine the prevalence of incidental diagnosis with NPAs observed over a decade and compare the analytical, clinical and treatment differences between those who were diagnosed either incidentally or symptomatically. We also intend to evaluate the pathology differences between both groups.Methods We retrospectively analysed patients aged =18 years with an apparent NFPA, defined as a pituitary lesion compatible with pituitary adenoma which is not associated with the clinical or biochemical evidence of a hormone-secreting tumour. Inclusion criteria included normal prolactin level for lesions <9 mm or a prolactin level <100 ng/mL for lesions =10 mm in maximal tumour diameter.Results We included 119 patients [53.8% males; mean age: 56.8 years (SD = 16.7)]. Diagnosis was incidental in 47.1% of patients, and many patients had unappreciated signs and symptoms of pituitary disease. In the symptomatic and incidental groups, 66.7% and 41.1% of patients had hypopituitarism, respectively (p = .005). Only 20.4% of patients incidentally diagnosed had microadenoma (p = .060). Hypopituitarism was present in 18.8% of those patients with microadenomas. Most tumours were macroadenomas (87.4%). Half of those patients diagnosed incidentally were submitted to surgery, compared with 75.8% of those who were diagnosed symptomatically (p = .004).Conclusions Nonfunctioning pituitary adenomas are commonly diagnosed incidentally, with many manifesting symptoms on examination. NFPAs incidentally diagnosed are more commonly macroadenomas and less frequently associated with hypopituitarism than symptomatic. Accordingly, if there was a greater level of knowledge and more suspicion about these pathologies, it might be possible to discover them earlier.

Keywords

• adenomas; hypopituitarism; nonfunctioning; pituitary