Download PDF
J Neurol Surg B Skull Base 2022; 83(01): 066-075
DOI: 10.1055/s-0040-1716673
Original Article

Size Matters: Rethinking of the Sizing Classification of Pituitary Adenomas Based on the Rates of Surgery: A Multi-institutional Retrospective Study of 29,651 Patients

Abhiraj D. Bhimani 
1   Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
2   Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States
,
Alexander J. Schupper
1   Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Gregory D. Arnone
3   Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, United States
,
Deeksha Chada
1   Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Anisse N. Chaker
2   Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States
,
Nicki Mohammadi
1   Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Costas G. Hadjipanayis
1   Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Ankit I. Mehta
2   Department of Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Pituitary adenomas are historically classified into microadenoma or macroadenomas based on size less than or greater than/equal to 1c m. “Giant” adenomas describe tumors ≥4 cm. The aim of this study is to present an evidence-based approach to size classification based on national trends.

Design The design involved is multi-institutional retrospective study.

Participants A total of 29,651 patients were studied from National Cancer Institute's SEER program from 2004 to 2016 across the United States.

Main Outcome Measures The main outcome measures include demographics, treatment characteristics, and overall survival in the population.

Results At the 20-mm threshold, the likelihood of operation exceeds the likelihood of nonoperative management. Patients with adenoma size 1 to 19 mm had significantly longer overall survival compared with 20 to 50 mm (Log rank: p < 0.0001). No survival difference was found between size 20 to 29 mm and larger. There was no significant difference in the rate of surgery between 30 to 39 mm and 40 to 50 mm tumors(p = 0.5035). Surgery group had a higher overall survival compared with nonsurgically managed patients (Log rank: p < 0.0001).

Conclusion Microadenoma has classically been used to describe pituitary tumors less than 1 cm, though no clinical significance of this threshold has been demonstrated. The current study suggests a size cut-off of 20 or 30 mm as more clinically relevant. Still, future studies are warranted to examine the significance of this classification by specific tumor type, and subclassified as appropriate. There is no difference in the rate of surgery or survival for adenomas between 30 and 50 mm, challenging the 4-mm cutoff threshold for “giant” adenoma.

Keywords

pituitary adenoma - giant adenoma - macroadenoma - microadenoma - surgery - SEER


Publication History

Received: 15 March 2020

Accepted: 03 August 2020

Article published online:
10 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Theodros D, Patel M, Ruzevick J, Lim M, Bettegowda C. Pituitary adenomas: historical perspective, surgical management and future directions. CNS Oncol 2015; 4 (06) 411-429
    CrossrefPubMedGoogle Scholar
  • 2 Hardy J. Transphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg 1969; 16: 185-217
    CrossrefPubMedGoogle Scholar
  • 3 Symon L, Jakubowski J, Kendall B. Surgical treatment of giant pituitary adenomas. J Neurol Neurosurg Psychiatry 1979; 42 (11) 973-982
    CrossrefPubMedGoogle Scholar
  • 4 Ntali G, Wass JA. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary 2018; 21 (02) 111-118
    CrossrefPubMedGoogle Scholar
  • 5 Chanson P, Maiter D. The epidemiology, diagnosis and treatment of prolactinomas: the old and the new. Best Pract Res Clin Endocrinol Metab 2019; 33 (02) 101290
    CrossrefPubMedGoogle Scholar
  • 6 Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Eur J Endocrinol 2018; 178 (05) 459-469
    CrossrefPubMedGoogle Scholar
  • 7 Olsson DS, Bryngelsson IL, Ragnarsson O. Time trends of mortality in patients with non-functioning pituitary adenoma: a Swedish nationwide study. Pituitary 2017; 20 (02) 218-224
    CrossrefPubMedGoogle Scholar
  • 8 Deb S, Vyas DB, Pendharkar AV. et al. Socioeconomic predictors of pituitary surgery. Cureus 2019; 11 (01) e3957
    PubMedGoogle Scholar
  • 9 Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA 2017; 317 (05) 516-524
    CrossrefPubMedGoogle Scholar
  • 10 Tampourlou M, Fountas A, Ntali G, Karavitaki N. Mortality in patients with non-functioning pituitary adenoma. Pituitary 2018; 21 (02) 203-207
    CrossrefPubMedGoogle Scholar
  • 11 Nabarro JD. Pituitary prolactinomas. Clin Endocrinol (Oxf) 1982; 17 (02) 129-155
    CrossrefPubMedGoogle Scholar
  • 12 Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary 2005; 8 (01) 3-6
    CrossrefPubMedGoogle Scholar
  • 13 Antonelli A, Palumbo C, Noale M. et al; and the Pros-IT CNR study group. Overview of potential determinants of radical prostatectomy versus radiation therapy in management of clinically localized prostate cancer: results from an Italian, prospective, observational study (the Pros-IT CNR study). Minerva Urol Nefrol 2020; 72 (05) 595-604
    PubMedGoogle Scholar
  • 14 Tolisano AM, Schauwecker N, Baumgart B. et al. Identifying disadvantaged groups for cochlear implantation: demographics from a large cochlear implant program. Ann Otol Rhinol Laryngol 2020; 129 (04) 347-354
    CrossrefPubMedGoogle Scholar
  • 15 Nayyar A, Strassle PD, Reddy KG. et al. Variations in the utilization of immediate post-mastectomy breast reconstruction. Am J Surg 2019; 218 (04) 712-715
    CrossrefPubMedGoogle Scholar
  • 16 Jefferson G. Extrasellar extensions of pituitary adenomas: (section of neurology). Proc R Soc Med 1940; 33 (07) 433-458
    PubMedGoogle Scholar
  • 17 Marigil Sanchez M, Karekezi C, Almeida JP. et al. Management of giant pituitary adenomas: role and outcome of the endoscopic endonasal surgical approach. Neurosurg Clin N Am 2019; 30 (04) 433-444
    CrossrefPubMedGoogle Scholar
  • 18 Sherlock M, Ayuk J, Tomlinson JW. et al. Mortality in patients with pituitary disease. Endocr Rev 2010; 31 (03) 301-342
    CrossrefPubMedGoogle Scholar
  • 19 Rosén T, Bengtsson BA. Premature mortality due to cardiovascular disease in hypopituitarism. Lancet 1990; 336 (8710): 285-288
    CrossrefPubMedGoogle Scholar
  • 20 Bates AS, Van't Hoff W, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab 1996; 81 (03) 1169-1172
    PubMedGoogle Scholar
  • 21 Bülow B, Hagmar L, Mikoczy Z, Nordström CH, Erfurth EM. Increased cerebrovascular mortality in patients with hypopituitarism. Clin Endocrinol (Oxf) 1997; 46 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 22 Svensson J, Bengtsson BA, Rosén T, Odén A, Johannsson G. Malignant disease and cardiovascular morbidity in hypopituitary adults with or without growth hormone replacement therapy. J Clin Endocrinol Metab 2004; 89 (07) 3306-3312
    CrossrefPubMedGoogle Scholar
  • 23 Penn DL, Burke WT, Laws ER. Management of non-functioning pituitary adenomas: surgery. Pituitary 2018; 21 (02) 145-153
    CrossrefPubMedGoogle Scholar