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Post-surgical management of non-functioning pituitary adenoma.
- Source :
-
Annales d'endocrinologie [Ann Endocrinol (Paris)] 2015 Jul; Vol. 76 (3), pp. 228-38. Date of Electronic Publication: 2015 Jun 23. - Publication Year :
- 2015
-
Abstract
- Post-surgical surveillance of non-functioning pituitary adenoma (NFPA) is based on magnetic resonance imaging (MRI) at 3 or 6 months then 1 year. When there is no adenomatous residue, annual surveillance is recommended for 5 years and then at 7, 10 and 15 years. In case of residue or doubtful MRI, prolonged annual surveillance monitors any progression. Reintervention is indicated if complete residue resection is feasible, or for symptomatic optic pathway compression, to create a safety margin between the tumor and the optic pathways ahead of complementary radiation therapy (RT), or in case of post-RT progression. In case of residue, unless the tumor displays elevated growth potential, it is usually recommended to postpone RT until progression is manifest, as efficacy is comparable whether treatment is immediate or postponed. The efficacy of the various RT techniques in terms of tumor volume control is likewise comparable. RT-induced hypopituitarism is frequent, whatever the technique. The choice thus depends basically on residue characteristics: size, delineation, and proximity to neighboring radiation-sensitive structures. Reduced rates of vascular complications and secondary brain tumor can be hoped for with one-dose or hypofractionated stereotactic RT, but there has been insufficient follow-up to provide evidence. Somatostatin analogs and dopaminergic agonists have yet to demonstrate sufficient efficacy. Temozolomide is an option in aggressive NFPA resistant to surgery and RT.<br /> (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Subjects :
- Adenoma diagnosis
Humans
Hypopituitarism etiology
Hypopituitarism therapy
Magnetic Resonance Imaging
Pituitary Neoplasms diagnosis
Radiotherapy adverse effects
Radiotherapy methods
Adenoma surgery
Adenoma therapy
Pituitary Neoplasms surgery
Pituitary Neoplasms therapy
Postoperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 2213-3941
- Volume :
- 76
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Annales d'endocrinologie
- Publication Type :
- Academic Journal
- Accession number :
- 26116412
- Full Text :
- https://doi.org/10.1016/j.ando.2015.04.003