Learn more about our Pituitary Disorders Program and Endonasal Endoscopic Surgery

Overview 

Endocrine-inactive adenomas do not result in excess hormone production. Instead they typically cause symptoms due to pressure on the normal pituitary gland and/or on structures near the pituitary such as the optic nerves and optic chiasm.

Symptoms 

Typical complaints of patients with an endocrine-inactive adenoma are those of Hypopituitarism, vision loss and headache. Hypopituitarism may manifest itself as fatigue, decreased mental function, weight gain, lethargy, joint pains, loss of sex drive, infertility and in women, irregular periods or amenorrhea. Almost all symptomatic endocrine-inactive adenomas are macroadenomas. Occasionally, they grow quite large and into the cavernous sinus, causing nerve compression and double vision. Some patients with large tumors may have hemorrhage into the tumor (pituitary apoplexy) causing rapid onset of headache, vision loss, double vision, and/or pituitary failure.

Diagnosis

Endocrine-inactive adenomas are diagnosed by imaging studies and hormonal testing. An MRI of the pituitary gland provides the most detail, although a brain MRI or brain CT scan will reveal most pituitary macroadenomas. Hormonal testing is also essential to evaluate for pituitary gland failure (Hypopituitarism). A complete pituitary hormonal analysis should be performed as described above and is ideally overseen by an endocrinologist.

Treatment

• Endonasal Endoscopic Surgery:Transsphenoidal surgery is considered first-line treatment for symptomatic endocrine-inactive adenomas and most incidentally discovered adenomas over 15 mm in size or that compress the optic nerves and optic chiasm. Because of improved visualization, the endonasal endoscopic approach is rapidly becoming the preferred method for removal of most pituitary adenomas, including endocrine-inactive adenomas. The long-term surgical remission or cure rate is 70-80% overall. Complete tumor removal is more likely with smaller tumors and those that do not invade the cavernous sinus and lower for larger tumors (over 3 cm) or invasive tumors.

 Endonasal tumor removal improves visual acuity and visual field deficits in 75-90% of patients and headache resolution is typically seen in over 80% of patients. Pituitary function is improved 20-50% of patients while new pituitary failure may occurs in 5% of patients. Patients who do not have hormonal recovery after surgery will require hormone replacement therapy. Major surgical complications after endonasal surgery such as vision loss, bleeding, stroke, cerebrospinal fluid leak and meningitis are quite low when performed by experienced neurosurgeons who often work with a Head & Neck surgeon. Because the endonasal endoscopic approach is so effective and relatively safe, it is rare that endocrine-inactive adenomas warrant transcranial removal. 

• Radiosurgery (SRT) or Stereotactic Radiotherapy (SRS):For patients who have residual tumor after the initial transsphenoidal surgery, focused radiation with SRT or SRS may be needed to control tumor growth. Both SRT and SRS halt tumor growth in at least 85-90% of patients. However, SRT and SRS may result in loss of normal pituitary function over 5 to 10 years. Neurologic complications such as visual loss and temporal lobe damage rarely occur with SRT and SRS.
• Medical Therapy:There is no effective medical therapy that reliably halts growth of endocrine-inactive adenomas.

See more: Endoscopic & keyhole surgery videos on BTC YouTube Channel