Giant pituitary adenoma: A cases report of 22

Document Type : Original

Authors

Assistant Professor, Department of Neurosurgery, Mashhad University of Medical Sciences

Abstract

Introduction: Although most pituitary neoplasms are benign, but some of them spreads to extrasellar structures. Definition of these giant pituitary adenoma is not clear. In order to clarify this question, we studied all pituitary adenomas with diameter of 30 mm or more and attempting to identify their typical and clinical features, complications and their prognosis.
Material and Methods:  In our prospective study since 1996 to 2006, 235 patients had been admitted and operated in neurosurgical centers, were determind. We evaluated the clinical and paraclinical signs and symptoms and surgical results  of  these tumors and Rate of  recurrence, morbidity  and  mortality  was determind. Then we compared  these  results with  other  studies. The processing of the results was achieved by SPSS (11.5) and statistical analysis with descriptive methods.   
Results: From 235 patients with pituitary adenoma in our study, 131 patients were male and 104 cases were female. The age of patients were 18 to 75 years with the average of 50.5%. 22 patients from 234 cases had giant pituitary adenoma. The diameter of  their tumors were equal or more than 30 mm.The most common clinical findings in our patients with giant pituitary adenoma were visual impairement (95.4%), headache (81.8%), gait disturbance (13.6%), decreasing of libido (18.1%)  and  papilledema (27.2%). In our study, the most common giant pituitary adenomas were non-functional adenomas and prolactinomas respectively. Mortality and post operative complications
of giant pituitary adenomas is more than other adenomas.
Conclusions: The giant pituitary adenoma is about 10.6% of total pituitary adenomas. Although  these lesions  are not  special and typical   tumors  but  in  order to more invading and more  spreading  to adjacent structures, they are different of other adenomas. They are characterized by a higher clinical signs and symptoms, higher frequency of neuro-ophthalmological symptoms and  hormonal deficits  and poorer  response to surgical treatments. The rate of  recurrence,  morbidity  and  mortality is  more  than other  adenomas too.
 

Keywords

References

1- Kovacs K, Horvath E. Pathology of pituitary tumors (review). Endocrinol Metab Clin N Am 1987; 16: 529–51.
2- Goel A, Nadkarni T. Surgical  management of giant pituitary tumors a review  of  30 cases. Acta  Neurochir (Wien) 1996; 138: 1042–9.
3- Grote E. Characteristics of giant pituitary adenomas. Acta Neurochir (Wien) 1982;  60: 141–53.
4- Corsello SM, Ubertini G, Altomare M, Lovicu RM, Migneco MG, Rota CA, Colosimo C. Giant prolactinomas in men: Efficacy of cabergoline treatment. Clin Endocrinol (Oxf) 2003; 58: 662–670.
 5- Gajidic Z, Ivekovic R, Rumboldt Z, Malenica M, Vizner B, Berkovic M. Chiasma syndrome in acromegalic patients: Correlation of neuroradiologic and neuro-ophthalmologic findings. Coll Anthropol 2002; 26: 601–608.  
6- Mohr G, Hardy J. Haemorrhage, necrosis and apoplexy in pituitary adenomas. Surg. Neurology 1982; 18: 181-189.
7- Vezina JL, Sutton TJ, Maltis R, Hardy J. Prolactin secreting pituitary microadenomas. Acta Radiology Suppl. 1975; 347: 561-566.
8- Garibi J, Pomposo I, Villar G, Gaztambide S. Giant pituitary adenomas . British J. of Neurosurgery, volume 16, Number2, 1 April 2002; pp. 133–139(7).
9- Auffarth GU, Faller U, Krastel H, Gobel HH, Volcker HE. Progressive, unilateral vision loss with changing nonspecific Visual field findings. Chromophobic anterior pituitary adenoma. Ophthalmologe 1997; 94: 532–3.
10- Rodríguez O, Mateos B, de la Pedraja R et al. Postoperative follow-up of pituitary adenomas after transsphenoidal resection: MRI and clinical correlation. Neuroradiology  1996; 38: 747–54.  
11- Ikeda H, Jokura H, Yoshimoto T. Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg  2001; 95:285–291.
12- Majos C, Coll S, Aguilera C, Acebes JJ, Pons LC. Imaging of giant pituitary adenomas. Neuroradiology 1998; 40: 651–5. 13- Sheehan JM, Vance ML, Sheehan JP, Ellegala DB, Laws ER Jr. Radiosurgery for Cushing's disease after failed transsphenoidal surgery. J Neurosurg  2000; 93:738–742.
14- Thapar K, Kovacs K. Neoplasms of the sellar region. In: Bigner DD, Mc London RE, Bruner JM, editor. In: Russell and Rubinstein,s pathology of tumors of the nervous  system. 6th Ed. vol.2 . London: Arnold; 1998 p. 561– 677.
15- Cappabianca P, Cavallo LM, Colao A, de Divitiis E: Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas.J Neurosurg.  2002; 97: 293–298.
16- Welsley A, King, MD, Gerald E, Rodth JR, Donald P. Becker, MD. Duncan Q. Mc Bride, MD. Skull base surgery, volum 6, number 1, Department of neurosurgery, New York, Jan 1996.  
17- Fahlbusch R,Ganslandt O, Buchfelder M, Schott W, Nimsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 2001; 95: 381–90.
18- Amar AP, Hinton DR, Krieger MD, Weiss MH. Invasive pituitary adenomas: Significance of proliferation parameters. pituitary 1999; 2: 117- 22.
19- Orrego JJ, Barkan AL: Pituitary disorders: Drug treatment options. Drugs 2000; 59: 93–106.
20- Chang CY, Luo CB, Teng MM et al. Computed tomography and magnetic resonance imaging characteristics  of giant  pituitary adenoma. J Formos Med Ass 2000; 99:833–8. 
Iranian Journal of Otorhinolaryngology
Volume 19, Issue 49 - Serial Number 49
September and October 2007
Pages 151-156

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