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Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors

Endocrinology Unit, Department of Medical Sciences, University of Milan, Fondazione IRCCS Ospedale Maggiore, Policlinico, Mangiagalli e Regina Elena, Via F Sforza, 35, 20122 Milano, Italy, ¹ Department of Medicine, Surgery and Dentistry, Unit of Medical Statistics, University of Milan, Milan, Italy, ² Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San Raffaele, Universita Vita-Salute, Milano, Italy, ³ Division of Endocrinology, Niguarda Hospital, Milan, Italy, ⁴ Division of Endocrinology, Bellaria Hospital, 40139 Bologna, Italy, ⁵ Division of Internal Medicine, University of Turin, Azienda Sanitaria Ospedaliera San Luigi, Regione Gonzole 10, 10043 Orbassano, Italy, ⁶ Division of Endocrinology, Galliera Hospital, 16128 Genova, Italy and ⁷ Division of Endocrinology, Santa Croce e Carle Hospital, Cuneo, Italy

(Correspondence should be addressed to A Lania; Email: andrea.lania{at}unimi.it)

Objective: The long-term outcome of non-functioning pituitary adenoma (NFPA) patients is not clearly established, probably due to the low annual incidence and prolonged natural history of these rare tumors. The aim of this study was to evaluate clinical data at presentation and long-term post-surgery and radiotherapy outcome in a cohort of patients with NFPA.

Design and methods: A computerized database was developed using Access 2000 software (Microsoft Corporation, 1999). Retrospective registration of 295 NFPA patients was performed in seven Endocrinological Centers of North West Italy. Data were analyzed by STATA software.

Results: The main presenting symptoms were visual defects (67.8%) and headache (41.4%) and the most frequent pituitary deficit was hypogonadism (43.3%), since almost all tumors were macroadenomas (96.5%). Surgery was the first choice treatment (98% of patients) and total debulking was achieved in 35.5%. Radiotherapy was performed as adjuvant therapy after surgery in 41% of patients. At the follow-up, recurrence occurred in 19.2% of patients without post-surgical residual tumor after 7.5 ± 2.6 years, regrowth in 58.4% of patients with post-surgical remnant after 5.3 ± 4.0 years and residue enlargement in 18.4% of patients post-surgically treated with radiotherapy after 8.1 ± 7.3 years.

Conclusions: Our database indicates that the goal of a definitive surgical cure has been achieved during the last decade in a low percentage of patients with NFPA. This tumor database may help to reduce the delay between symptom onset and diagnosis, to assess prognostic parameters for the follow-up of patients with different risk of recurrence and to define the efficacy and safety of different treatments and their association with mortality/morbidity.

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