Nonfunctional pituitary adenoma - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Clinically nonfunctional pituitary adenomas (CNFPAs) are considered here; functional pituitary adenomas (e.g., acromegaly, Cushing syndrome, prolactinoma) are dealt with separately.
Small pituitary tumors (<4 mm) are common and have been reported in up to 10% of MRIs in the general population. Only a small fraction of such tumors are associated with clinical features suggestive of pituitary disorder.
Radiologically, CNFPAs are classified as microadenomas (<1 cm diameter) or macroadenomas (≥1 cm diameter); they may have suprasellar extension toward the optic chiasm, lateral extension into the cavernous sinuses, or downward extension into the sphenoid.
Patients with nonfunctional pituitary microadenomas require limited follow-up, but pituitary macroadenomas need to be followed for life.
Nonfunctional pituitary macroadenomas typically come to medical attention with features of mass effect such as headaches, visual field deficits, hypopituitarism, and rarely cranial nerve palsies.

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History & Exam
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Diagnostics Tests
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Precontrast coronal (A) and sagittal (B) MR images of a patient with a pituitary macroadenoma (arrow, A). The pituitary mass extends toward the optic chiasm with some pressure effect
Precontrast (A) and postcontrast (B) coronal MR images of a patient with a small pituitary microadenoma. The pituitary lesion enhances less than the normal pituitary gland following gadolinium and appears hypodense compared with the normal pituitary gland (arrow, B)

Citations

Key Articles

Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017 Feb 7;317(5):516-24.[Abstract]
Mercado M, Melgar V, Salame L, et al. Clinically non-functioning pituitary adenomas: pathogenic, diagnostic and therapeutic aspects. [in spa]. Endocrinol Diabetes Nutr. 2017 Aug-Sep;64(7):384-95.[Abstract]
Aghi MK, Chen CC, Fleseriu M, et al. Congress of neurological surgeons systematic review and evidence-based guidelines on the management of patients with nonfunctioning pituitary adenomas: executive summary. Neurosurgery. 2016 Oct;79(4):521-3.[Abstract][Full Text]
Esposito D, Olsson DS, Ragnarsson O, et al. Non-functioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019 Aug;22(4):422-34.[Abstract][Full Text]
Minniti G, Flickinger J. The risk/benefit ratio of radiotherapy in pituitary tumors. Best Pract Res Clin Endocrinol Metab. 2019 Apr;33(2):101269.[Abstract]

Referenced Articles

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