Are there any medical therapies for nonfunctioning adenomas? No. There are currently no effective, or U.S. Food and Drug Administration–approved, medical therapies for NFAs. Despite the presence of DA receptors on NFAs, the efficacy of DA agonists (i.e., bromocriptine and cabergoline) on tumor growth control varies widely. In addition, there is insufficient evidence to recommend …
What are the treatment indications and options for incidentalomas and nonfunctioning pituitary tumors? With the exception of prolactinomas, functional pituitary adenomas, including incidentalomas, should be managed first line with transsphenoidal surgery (TSS). In addition, TSS is first-line therapy for nonfunctioning adenomas with the following indications: • Symptoms of visual field deficits, vision loss or ophthalmoplegia • Compression …
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What additional testing is needed to evaluate a pituitary adenoma? Ideally, a high-resolution, gadolinium-enhanced, pituitary-dedicated magnetic resonance imaging (MRI) should be performed to characterize the pituitary lesion and its proximity to adjacent structures. Conversely, a contrast-enhanced computed tomography can be performed if a MRI is contraindicated (i.e., corporal metal, pacemakers). Compared with the normal pituitary …
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Does an elevated serum PRL level indicate that a tumor is a functioning prolactinoma? No. The secretion of PRL is negatively regulated by hypothalamic dopamine (DA) via the pituitary stalk. Stalk compression from a large nonfunctioning tumor can impair DA delivery and, thus, increase PRL levels. The serum PRL rarely exceeds 100 to 150 ng/mL …
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How should a pituitary adenoma, including a pituitary incidentaloma, initially be evaluated? A thorough history and physical examination can detect symptoms and/or signs of pituitary hormone excess or hypopituitarism. Baseline pituitary hormone testing should include the following serum/plasma measurements: an a.m. cortisol, ACTH, prolactin (PRL), GH, insulin-like growth factor 1 (IGF-1), TSH, free thyroxine (free …
Is the pathogenesis for sporadic nonfunctioning pituitary tumors known? Analyses of sporadic NFAs have revealed a number of interesting candidate mutations: loss of tumor suppressor genes, oncogenic drivers, and epigenetic mutations. However, these are identified in only a relatively small subset of tumors.
Are nonfunctioning pituitary adenomas heritable? Less than 5% of NFAs are associated with hereditary syndromes, or germline mutations, which include multiple endocrine neoplasia type 1 and type 4 (MEN-1, MEN-4), familial isolated pituitary adenomas (FIPA), or succinate dehydrogenase mutations. NFAs are an uncommon manifestation of FIPA (< 20%), but this should be considered in young …