ABSTRACT
Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors’ experience. Arch Endocrinol Metab. 2016;60(4):374-90
Clinically nonfunctioning pituitary adenoma; sellar mass; transsphenoidal surgery; radiotherapy; cabergoline
NFPA: nonfunctioning pituitary adenoma; MRI: magnetic resonance imaging; CAB: cabergoline; RT: radiotherapy.* For cases that can be followed up with MRI, are asymptomatic from a visual point of view and the tumor is located far from the optical pathways, there is no need for visual field perimetry.1 For asymptomatic patients with no compression of the optic pathway but with tumors near the optic chiasm, the decision between surgery and follow-up should be individualized, taking into consideration issues such as age, fertility/pregnancy, pituitary function and the patient’s desire.2 RT can be used as primary therapy for patients with tumors near or that reach the optic pathways and present surgical risk high enough to contraindicate surgery.3 Tumors with pathologic features of aggressiveness are those with a high mitotic index, Ki-67 > 3% and extensive immunostaining for p53.