Hormone-Secreting Pituitary Adenomas

Introduction: The consistency of pituitary adenoma influences the possibility of trans-sphenoidal pituitary adenoma resection. The consistency of adenomas versus MRI studies was compared.

Material and Methods: In the period 1998 through 2002, 159 patients with pituitary adenomas were treated in the authors' department. The group consisted of 74 hormone-secreting pituitary adenomas. In 45 cases hypersecretion of STH was the reason for surgery, in 24 cases hyperproduction of ACTH, in 3 cases FSH, and 4 cases TSH. Prolactinomas were excluded in this report because the reason for surgery in those cases was different. The mean age of the patients was 43 years: the youngest one was 18 years old, the oldest one 72 years old. The group consisted of 39 men and 35 women.

Results: Satisfactory hormone decrease was achieved in 59% of cases. In the remaining cases the decrease was not substantial enough. Twelve percent of patients were treated by D2 agonists (in 75% of those cases no residuum or regrowth of the adenoma was found). Stereotactic radiosurgery was applied in 28% of cases. The surgical mortality of this group was 0% and morbidity was 2% (in 1 case there was visual impairment, in 1 case CSF leak).

Conclusions: The authors believe that results can be improved if the treatment modality/surgical strategy could be based on prior knowledge of the adenoma consistency—hard versus soft. MR studies were compared to surgical data and functional results. The treatment algorhithms based on the collected data stress the need of a multimodality treatment approach.