What is the differential diagnosis and management of postoperative polyuria? The differential diagnosis for postoperative polyuria includes (1) fluid mobilization from perioperative fluid administration; (2) central DI; (3) osmotic diuresis (i.e., glycosuria); or (4) GH salt and water mobilization after resection of a GH-secreting tumor. The hallmark of central DI is high-volume output (> 250 …
What endocrine complications occur in the perioperative period? Abnormalities of fluid and sodium balance are common after TSS because of antidiuretic hormone (ADH) dysregulation from pituitary stalk and/or posterior pituitary gland manipulation. Transient diabetes insipidus (DI), caused by impaired ADH secretion, may occur in the first 1 to 2 postoperative days in ∼ 20% to …
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How effective is radiation therapy for NFAs? External beam radiation therapy is excellent for controlling NFA growth; > 90% progression-free survival rates have been reported at 10 years in most series. Tumor control occurs regardless of the radiation technique or NFA subtype. Two general radiation modalities are used for pituitary adenomas: (1) conventional/conformal radiation, which …
What are the risks of regrowth and treatment options for persistent/recurrent NFAs? The long-term risk of NFA recurrence, after TSS, is estimated to be 33% to 47% and 6% to 16% for patients with, and without, radiographic evidence of residual tumors, respectively, on 3-month post-TSS imaging. Risk factors for regrowth include large/invasive tumors, cavernous sinus/bony/dural …
How successful is transsphenoidal surgery for nonfunctioning adenomas? • Transsphenoidal resection: The rates of successful NFA resection are a function of the tumor size and degree of invasiveness. Gross total resection rates are highest for tumors localized exclusively in the sella, but decreases to < 50% when there is cavernous sinus invasion or bony involvement. • Pituitary hormone …
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What is the natural history of nonfunctioning pituitary tumors? The growth frequency of NFAs is estimated to be ≈ 10% to 13% for microadenomas and ≈ 34% to 40% for macroadenomas over 8 years. Progressive tumor growth usually proceeds at very slow rates (1–2 mm/year). Long term, microadenomas rarely grow to be > 1 cm …
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How should a pituitary nonfunctioning adenoma including a pituitary incidentaloma be followed? For NFA/microadenomas, follow-up MRI imaging is recommended at 1-, 2-, and 5-year intervals. Pituitary hormone reevaluation should be considered if there has been significant interval tumor growth, or as clinically indicated. TSS is recommended for any significant interval tumor growth associated with vision …