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Clinically non-functioning pituitary adenomas: Pathogenic, diagnostic and therapeutic aspects.

Authors
  • Mercado, Moises1
  • Melgar, Virgilio2
  • Salame, Latife3
  • Cuenca, Dalia4
  • 1 Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico; Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico. Electronic address: [email protected] , (Mexico)
  • 2 Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico. , (Mexico)
  • 3 Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional S.XXI, IMSS, Mexico City, Mexico. , (Mexico)
  • 4 Department of Medicine, American British Cowdray Medical Center, Mexico City, Mexico. , (Mexico)
Type
Published Article
Journal
Endocrinologia, diabetes y nutricion
Publication Date
Jan 01, 2017
Volume
64
Issue
7
Pages
384–395
Identifiers
DOI: 10.1016/j.endinu.2017.05.009
PMID: 28745610
Source
Medline
Keywords
Language
Spanish
License
Unknown

Abstract

Clinically non-functioning pituitary adenomas (NFPAs) are among the most common tumors in the sellar region. These lesions do not cause a hormonal hypersecretion syndrome, and are therefore found incidentally (particularly microadenomas) or diagnosed based on compressive symptoms such as headache and visual field defects, as well as clinical signs of pituitary hormone deficiencies. Immunohistochemically, more than 45% of these adenomas stain for gonadotropins or their subunits and are therefore called gonadotropinomas, while 30% of them show no immunostaining for any hormone and are known as null cell adenomas. The diagnostic approach to NFPAs should include visual field examination, an assessment of the integrity of all anterior pituitary hormone systems, and magnetic resonance imaging of the sellar region to define tumor size and extension. The treatment of choice is transsphenoidal resection of the adenoma, which in many instances cannot be completely accomplished. The recurrence rate after surgery may be up to 30%. Persistent or recurrent adenomas are usually treated with radiation therapy. In a small proportion of these cases, drug treatment with dopamine agonists and, to a lesser extent, somatostatin analogs may achieve reduction or at least stabilization of the tumor. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

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