Neurosurgical Diseases and Disorders (A-L) / Endocrine Inactive Adenomas
General Information
- These are a relatively common type of pituitary adenoma. There are no symptoms related to excessive hormone production. Instead, symptoms are caused by increasing tumor size and resulting pressure on the normal pituitary gland and on structures near the pituitary, such as the optic nerves and adjacent portions of the brain.
- The vast majority of these tumors are benign, or not malignant. Most are large (macroadenoma), measuring more than 1 cm in size when finally diagnosed. Occasionally they grow quite large and invade the sinus cavity, causing nerve compression and double vision.
- Some patients with large tumors may have acute bleeding into the tumor (pituitary apoplexy). Endocrine-inactive adenomas may also be discovered during an evaluation for another problem, such as a head injury.
Symptoms
- The most common symptom leading to diagnosis is progressive loss of peripheral vision.
- The major symptoms of endocrine-inactive adenomas are similar to those of pituitary failure (hypopituitarism), including loss of appetite, weight loss, fatigue, decreased energy, decreased mental function, dizziness and joint pain.
- In women, symptoms also include infertility and irregular or nonexistent menses.
- In men, symptoms also include infertility, impotence and loss of sex drive, and loss of body and facial hair.
- Headache is more common with larger tumors.
Diagnosis
- Hormonal
- For patients with symptoms suggestive of pituitary failure (hypopituitarism), a complete evaluation of the endocrine system should be performed.
- Based on results of these blood tests, additional hormonal studies may be ordered.
- Ophthalmologic
- For patients with visual complaints, an ophthalmologist (preferably a neuro-ophthalmologist) should evaluate the patient.
- This evaluation should include acuity testing of each eye and formal visual field testing to determine if there is loss of peripheral vision.
- Imaging
Treatment/Outcome
- Surgery
- For the great majority of patients with symptomatic endocrine-inactive adenomas, transsphenoidal surgery and adenoma removal is the preferred and most effective therapy.
- The long-term cure or control rate is 70 percent to 80 percent. The cure rate is generally higher for smaller tumors and those that do not invade the sinus cavity.
- Overall, surgery improves vision in 75 percent to 90 percent of patients, headache in 80 percent to 90 percent, and suppressed pituitary function in 10 percent to 30 percent.
- Patients without hormonal recovery after surgery will require long-term hormone replacement therapy
- Medical
- There is no known effective medical therapy that reliably slows or stops growth of endocrine inactive adenomas.
- Radiotherapy
- Radiation is generally used as a second line therapy for endocrine-inactive tumors.
- For patients with residual tumor or regrowth after the initial surgery, radiation or repeat transsphenoidal surgery or both are options.
- Both conventional (external beam) and stereotactic radiosurgery are relatively effective in controlling growth, but stereotactic radiation can deliver a higher radiation dose to the tumor more safely.
- External beam radiation causes loss of remaining normal pituitary function over five to 10 years.
- Stereotactic radiosurgery may also cause loss of pituitary function but less frequently then external beam radiation.
The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide
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