Alberto M Pereira1, Nienke R Biermasz. 1. Department of Endocrinology and Metabolism, Leiden University Medical Center, The Netherlands. a.m.pereira@lumc.nl
Abstract
OBJECTIVES: All evidence for treatment and follow-up for nonfunctioning pituitary adenomas (NFMA) is based on observational studies. The objective was to critically review the contributions of the last 10 years on treatment of NFMA. MATERIALS AND METHODS: Systematic review. RESULTS: Transsphenoidal surgery remains the cornerstone of treatment of NFMA. When compared to the microsurgical procedure, some, but not all, studies favor endoscopy, but endocrinological outcome is not different. Radiosurgery results in a high and durable rate of tumor control, including in those previously treated by conventional radiotherapy, but the risk of developing hypopituitarism is comparable to the risk after conventional radiotherapy. In selected patients without visual field defects, a wait-and-see approach with frequent evaluation of visual fields is possible, without the risk of irreversibly compromising visual function. Tumor progression in NFMA is difficult to predict, but the MIB-1 LI is clinically useful and is indicative of invasiveness, but does not predict recurrence. To date, the potential contribution of other proliferation markers still requires further validation, and effective medical treatment strategies are not available. New features are the role of temozolomide and rapamicin as potential therapeutical targets, combined with octreotide. Although chimeric sst-DA analogues effectively inhibit proliferation in vitro, the effects of these molecules have not yet been evaluated in clinical trials with patients with NFMA. CONCLUSION: Surgery, followed by radiotherapy or radiosurgery in case of remnant or recurrence, remains the cornerstone of treatment of NFMA. Currently, medical treatment cannot yet be incorporated in routine clinical practice.
OBJECTIVES: All evidence for treatment and follow-up for nonfunctioning pituitary adenomas (NFMA) is based on observational studies. The objective was to critically review the contributions of the last 10 years on treatment of NFMA. MATERIALS AND METHODS: Systematic review. RESULTS: Transsphenoidal surgery remains the cornerstone of treatment of NFMA. When compared to the microsurgical procedure, some, but not all, studies favor endoscopy, but endocrinological outcome is not different. Radiosurgery results in a high and durable rate of tumor control, including in those previously treated by conventional radiotherapy, but the risk of developing hypopituitarism is comparable to the risk after conventional radiotherapy. In selected patients without visual field defects, a wait-and-see approach with frequent evaluation of visual fields is possible, without the risk of irreversibly compromising visual function. Tumor progression in NFMA is difficult to predict, but the MIB-1 LI is clinically useful and is indicative of invasiveness, but does not predict recurrence. To date, the potential contribution of other proliferation markers still requires further validation, and effective medical treatment strategies are not available. New features are the role of temozolomide and rapamicin as potential therapeutical targets, combined with octreotide. Although chimeric sst-DA analogues effectively inhibit proliferation in vitro, the effects of these molecules have not yet been evaluated in clinical trials with patients with NFMA. CONCLUSION: Surgery, followed by radiotherapy or radiosurgery in case of remnant or recurrence, remains the cornerstone of treatment of NFMA. Currently, medical treatment cannot yet be incorporated in routine clinical practice.
Authors: Antonio Di Ieva; Fabio Rotondo; Luis V Syro; Michael D Cusimano; Kalman Kovacs Journal: Nat Rev Endocrinol Date: 2014-05-13 Impact factor: 43.330