Advances in Surgery for Pituitary Tumors
Advances in Surgery for Pituitary Tumors
US Endocrinology - Volume 5 Issue 1
Published: January 2010
Published: January 2010
Abstract
Recent studies have provided important new information regarding the behavior and surgical management of pituitary tumors. One population study from Belgium confirmed that incidentalomas are relatively common. Basic researchers found that stem cells continue to contribute cells to the normal pituitary gland throughout adulthood in mice. A new imaging technique, 3D anisotropy contrast magnetic resonance imaging (MRI), may improve our ability to predict surgical outcome for adenomas. A study from the University of California, San Francisco (UCSF) showed that radiation therapy improved the long-term outcome of adenomas after subtotal resection, but not after total resection. Other studies provided additional information on management of post-operative steroid replacement and cerebrospinal fluid (CSF) fistulae after pituitary surgery. New recommendations for management of Cushing’s disease were provided by a panel of experts after a meeting in Budapest, Hungary, and surgical results for Cushing’s disease from a large, single-center experience were published. Overall, these studies highlight the beneficial effects of surgery for pituitary tumors, as well as addressing challenges that remain.
Keywords
Adenoma, incidentaloma, stem cells, radiation therapy, minimally invasive surgery, peri-operative management, cerebrospinal fluid fistula, diabetes insipidus, Cushing’s disease, thyroid-stimulating hormone (TSH)
Disclosure: The author has no conflicts of interest to declare. Acknowledgement: This article was previously published in US Neurology and is reprinted here with full permission. Citation: Roper SN, Advances in Surgery for Pituitary Tumors, US Neurology, 2008;4(2):36–9.
Received: October 28, 2009 Accepted: June 22, 2009
Correspondence: Steven N Roper, MD, Department of Neurosurgery, University of Florida, 100 South Newell Drive, Room L2-100, Gainesville, FL 32610. E: roper@neurosurgery.ufl.edu
Although benign in nature, pituitary tumors continue to offer many opportunities for improvement in therapy. Goals of treatment include complete removal or ablation of tumor cells, maintenance of normal pituitary function, normalization of elevated hormone levels in endocrine-active tumors, and minimizing adverse effects from therapy. There have been many recent advances related to the surgical treatment of pituitary tumors and the purpose of this article is to review some of the more significant ones.
Behavior of Pituitary Tumors
One of the most notable features of pituitary adenomas is their ubiquity in population studies compared with the relatively small number of tumors that actually present with clinical problems. Pituitary adenomas have been consistently reported in up to 25% of people in autopsy studies dating back to 1936.1 More recent studies have attempted to clarify the relative prevalence of ‘incidentalomas’ compared with clinically relevant tumors. A meta-analysis performed in 20042 found an incidence of 16.7% with autopsies reporting 14.4% and radiologic studies finding a rate of 22.5%. Prolactinomas represented 25–41% of incidentalomas in studies that included immunohistochemical staining.3,4 A recent population study from Belgium5 found a prevalence of clinically relevant pituitary adenomas of 94 per 100,000. Of this group, 66% were prolactinomas, 14.7% were not endocrine-active, 13.2% had acromegaly, 5.9% had Cushing’s disease, and 20.6% had hypopituitarism. These same authors provided a concise set of recommendations for management of incidentalomas, including initial evaluation and periodic follow-up with magnetic resonance imaging (MRI) and endocrine studies.6
To read full article please click here: US Endocrinology - Volume 5 Issue 1.
Keywords:
Adenoma, incidentaloma, stem cells, radiation therapy, minimally invasive surgery, peri-operative management, cerebrospinal fluid fistula, diabetes, insipidus, Cushing’s disease, thyroid-stimulating hormone (TSH), adenoma adrenal glands, pituitary adenoma, CSF leak cerebrospinal fluid, diagnosis of cerebrospinal fluid fistula, cerebrospinal fluid shunts, Cushing’s disease syndrome, Cushing’s disease cortisole, symptoms of Cushing’s disease, Cushing’s disease diabetes,
Adenoma, incidentaloma, stem cells, radiation therapy, minimally invasive surgery, peri-operative management, cerebrospinal fluid fistula, diabetes, insipidus, Cushing’s disease, thyroid-stimulating hormone (TSH), adenoma adrenal glands, pituitary adenoma, CSF leak cerebrospinal fluid, diagnosis of cerebrospinal fluid fistula, cerebrospinal fluid shunts, Cushing’s disease syndrome, Cushing’s disease cortisole, symptoms of Cushing’s disease, Cushing’s disease diabetes,
