Therapeutic Strategy for Incidentally Found Pituitary Tumors(“Pituitary Incidentalomas”)

Therapeutic Strategy for Incidentally Found Pituitary Tumors(“Pituitary Incidentalomas”) AbstractOBJECTIVE:To evaluate therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”), we -analyzed the results of magnetic resonance imaging findings and of ophthalmological and endocrinological-studies in 28 cases with long-term follow-up (Hardy's classification : Grade A, 24 cases; Grade B, 4 cases).METHODS:Only cases of non functioning macro incident alom a were analyzed in this study. Cases with ophthalmological and/or endocrinologicaldys functionrevealed by the first evaluation, even with out subjective manifestations, were excludedfrom the category. Incidentally found functioning tumors were also excluded.RESULTS:The follow-up periodranged from 6 months to 10 years (mean, 5.6 yr). M agneticresonance imaging and ophthalmological and endocrinological studies, including provocation tests, were conducted once peryear.No surgical treatment was required in any case of Grade A tumors and in two cases of Grade B tumors because of no changes revealed by these studies. Transsphenoidal surgery was performed in the remain ng two cases of Grade B tumors because of pituitary apoplexy. The second case was one of head injury-induced apoplexy. There were no deficits after surgery. The MIB-1 index did not differ in operated incidentaloma and symptomatic pituitary tumors.CONCLUSION:Unless ophthalmological and endocrinological function is noted, surgical treatment is not required for Grad e A pituitary in identalomas. It is not too late toremove the tumor surgically, even after some function develops. A patient having a tumor larger than Grade A can still be managed conservatively; however, the patient should be care fully informed of the possibility of pituita ry apoplexy, and emergency transsphenoidal surgery is indicated if apoplexy occurs. (Neurosurgery 43 :1344–1350, 1998) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Therapeutic Strategy for Incidentally Found Pituitary Tumors(“Pituitary Incidentalomas”)

Therapeutic Strategy for Incidentally Found Pituitary Tumors(“Pituitary Incidentalomas”)

C L I N I C A L S T U D IE S Therapeutic Strategy for Incidentally Found Pituitary Tumors ifll ("Pituitary Incidentalomas") T it! * ■ Shigeru Nishizawa, M.D., Ph.D., j* rt) Seiji Ohta, M.D., Ph.D., Tetsuo Yokoyama, M.D., Ph.D., ft f t Kenichi Uemura, M .D., Ph.D. •rc 5 e Department of Neurosurgery, Hamamatsu University School of M edicine, J I Ham amatsu, )apan Ii. C O B J E C T I V E : T o e v a lu a t e t h e r a p e u t ic s t r a t e g y f o r i n c i d e n t a l l y f o u n d p i t u i t a r y t u m o r s ( " p i t u i t a r y in c id e n t a lo m a s " ) , we - a n a l y z e d th e r e s u lt s o f m a g n e t ic r e s o n a n c e i m a g i n g f i n d i n g s a n d o f o p h t h a l m o l o g i c a l a n d e n d o c r in o lo g ic a l - s t u d ie s in 2 8 c a s e s w it h lo n g - t e r m f o l l o w - u p ( H a r d y ' s c l a s s i f i c a t i o n : G r a d e A , 2 4 c a s e s ; G r a d e B , 4 case s). [ s M E T H O D S : O n l y c a s e s o f n o n f u n c t i o n i n g m a c r o i n c i d e n t a l o m a w e r e a n a l y z e d in t h is s t u d y . C a s e s w it h ophthalm o- l o g i c a l a n d / o r e n d o c r i n o l o g i c a l d y s f u n c t io n r e v e a le d b y th e f ir s t e v a l u a t i o n , e v e n w i t h o u t s u b j e c t i v e m a n ife sta -. t io n s , w e r e e x c l u d e d f r o m th e c a t e g o r y . I n c i d e n t a l l y f o u n d f u n c t i o n i n g t u m o r s w e r e a ls o e x c l u d e d . » R E S U L T S : T h e f o l l o w - u p p e r io d r a n g e d f r o m 6 m o n t h s to 1 0 y e a r s ( m e a n , 5 . 6 y r ) . M a g n e t i c r e s o n a n c e im a g in g and o p h t h a lm o lo g ic a l a n d e n d o c r in o lo g ic a l s tu d ie s , i n c lu d i n g p r o v o c a t io n tests, w e r e c o n d u c t e d o n c e p e r year. No i s u r g ic a l tre a tm e n t w a s r e q u ir e d in a n y c a s e o f G r a d e A t u m o r s a n d in t w o c a s e s o f G r a d e B...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199812000-00047
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:To evaluate therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”), we -analyzed the results of magnetic resonance imaging findings and of ophthalmological and endocrinological-studies in 28 cases with long-term follow-up (Hardy's classification : Grade A, 24 cases; Grade B, 4 cases).METHODS:Only cases of non functioning macro incident alom a were analyzed in this study. Cases with ophthalmological and/or endocrinologicaldys functionrevealed by the first evaluation, even with out subjective manifestations, were excludedfrom the category. Incidentally found functioning tumors were also excluded.RESULTS:The follow-up periodranged from 6 months to 10 years (mean, 5.6 yr). M agneticresonance imaging and ophthalmological and endocrinological studies, including provocation tests, were conducted once peryear.No surgical treatment was required in any case of Grade A tumors and in two cases of Grade B tumors because of no changes revealed by these studies. Transsphenoidal surgery was performed in the remain ng two cases of Grade B tumors because of pituitary apoplexy. The second case was one of head injury-induced apoplexy. There were no deficits after surgery. The MIB-1 index did not differ in operated incidentaloma and symptomatic pituitary tumors.CONCLUSION:Unless ophthalmological and endocrinological function is noted, surgical treatment is not required for Grad e A pituitary in identalomas. It is not too late toremove the tumor surgically, even after some function develops. A patient having a tumor larger than Grade A can still be managed conservatively; however, the patient should be care fully informed of the possibility of pituita ry apoplexy, and emergency transsphenoidal surgery is indicated if apoplexy occurs. (Neurosurgery 43 :1344–1350, 1998)

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1998

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