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Exp Clin Endocrinol Diabetes 2021; 129(03): 250-264
DOI: 10.1055/a-1373-4087
Guideline

First German Guideline on Diagnostics and Therapy of Clinically Non-Functioning Pituitary Tumors

Authors

  • Timo Deutschbein 

    1   Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
    2   Medicover Oldenburg MVZ, Oldenburg, Germany

  • Cornelia Jaursch-Hancke

    3   Department of Endocrinology, German Clinic of Diagnostics, Wiesbaden, Germany

  • Ulrich J. Knappe

    4   Department of Neurosurgery, Johannes Wesling Hospital, University Hospital of the Ruhr-University Bochum, Minden, Germany

  • Wolfgang Saeger

    5   Institute for Neuropathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

  • Jörg Flitsch

    6   Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

  • Jörg Bojunga

    7   Department of Internal Medicine I, Division of Endocrinology, Goethe-University Hospital, Frankfurt, Germany

  • Michael Buchfelder

    8   Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany

  • Beate Ditzen

    9   Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Heidelberg, Germany

  • Rüdiger Gerlach

    10   Department of Neurosurgery, Helios Klinikum Erfurt, Erfurt, Germany

  • Elfriede Gertzen

    11   Niels Stensen Bildungszentrum, Osnabrück, Germany

  • Jürgen Honegger

    12   Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Germany

  • Gerhard A. Horstmann

    13   Gamma Knife Center Krefeld, Krefeld, Germany

  • Arend Koch

    14   Department of Neuropathology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany

  • Ilonka Kreitschmann-Andermahr 

    15   Department of Neurosurgery and Spine Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany

  • Mirjam Kunz

    16   Schwerpunktpraxis für Diabetologie und Endokrinologie, Ludwigshafen, Germany

  • Wolf A. Lagrèze

    17   Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany

  • Nils H. Nicolay

    18   Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany

  • Werner Paulus

    19   Institute of Neuropathology, University Hospital Münster, Münster, Germany

  • Martin Reincke

    20   Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany

  • Manuel A. Schmidt

    21   Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

  • Matthias M. Weber

    22   Department of Endocrinology and Metabolism, I Medical Clinic, University Hospital, Johannes Gutenberg University of Mainz, Mainz, Germany

  • Helmut Wilhelm

    23   Centre for Ophthalmology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany

  • Martin Fassnacht

    1   Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany

Funding: The guideline was initiated by the German Society of Endocrinology. All incurring costs were financed exclusively by the German Society of Endocrinology and the participating professional societies.
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Abstract

Although non-functioning pituitary tumors are frequent, diagnostic and therapeutic concepts are not well standardized. We here present the first German multidisciplinary guideline on this topic. The single most important message is to manage the patients by a multidisciplinary team (consisting at least of an endocrinologist, a neurosurgeon, and a (neuro-) radiologist). The initial diagnostic work-up comprises a detailed characterization of both biochemical (focusing on hormonal excess or deficiency states) and morphological aspects (with magnetic resonance imaging of the sellar region). An ophthalmological examination is only needed in presence of symptoms or large tumors affecting the visual system. Asymptomatic, hormonally inactive tumors allow for a 'wait and scan' strategy. In contrast, surgical treatment by an experienced pituitary surgeon is standard of care in case of (impending) visual impairment. Therapeutic options for incompletely resected or recurrent tumors include re-operation, radiotherapy, and observation; the individual treatment plan should be developed multidisciplinary. Irrespective of the therapeutic approach applied, patients require long-term follow-up. Patient with larger pituitary tumors or former surgery/radiotherapy should be regularly counseled regarding potential symptoms of hormonal deficiency states.

Key words

Adenoma - endocrinology - hormonally inactive - hormones - imaging - neuropathology - neuroradiology - neurosurgery - NFA - pathology - radiology - radiotherapy - recommendation - surgery - sellar mass - treatment.

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Publication History

Received: 23 January 2021
Received: 23 January 2021

Accepted: 25 January 2021

Article published online:
09 March 2021

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