Prognosis
Patients with clinically nonfunctional pituitary adenomas (CNFPAs) generally have a good prognosis. The 10-year progression-free survival for pituitary adenoma is 80% to 94%.[81] However, the standardized mortality ratio in patients with CNFPA is higher than that of the general population, although advances in the management of these patients (and particularly in the substitution of pituitary hormone deficits) has had a positive impact on survival.[82]
Microadenomas do well with observation. The risk of tumor growth in patients with pituitary microadenomas is small - about 0% to 14% over a mean follow-up period of 1.8 to 6.7 years. These tumors are generally benign and slow-growing. Macroadenomas have a propensity to grow, and even when diagnosed as asymptomatic, need very close monitoring. In a meta-analysis of patients with pituitary incidentalomas and nonfunctional pituitary adenomas, the rate of tumor growth was higher for macroadenomas, at 12.5 per 100 person-years (PYs), compared with 3.3 per 100 PYs for microadenomas and 0.05 per 100 PYs in those with cystic lesions.[38]
In a retrospective study, a higher rate of recovery of hypopituitarism was reported in patients <45 years old compared with patients in the age groups of 45 to 64 and over 65 years.[83] In another study, a more favorable hormonal outcome was reported in premenopausal women compared with men and postmenopausal women.[84]
Patients with hypopituitarism need to be diagnosed early and appropriately treated with hormone replacement. A higher risk for metabolic syndrome - in particular dyslipidemia - has been reported in patients with CNFPAs when compared with the general population, which was only partly explained by the presence of hypopituitarism or hormonal replacement therapy.[85] Patients with CNFPAs may be at increased risk of death, especially secondary to cardiovascular disease.[86]
There is concern about long-term sequelae of radiation therapy, particularly hypopituitarism, which is seen in 30% to 60% of patients 5 to 10 years treated with conventional radiation therapy.[65] In patients treatment with stereotactic radiosurgery, the 5-year incidence of new or worsening pituitary deficits ranges from 10% to 40%.[65] Other rare side effects may include optic neuropathy, cerebrovascular accidents, and secondary malignancies.[65] Patients need to be closely followed by imaging studies, preferably MRI.
Patients with pituitary adenomas have been shown to have a lower quality of life (QoL) before and after pituitary surgery compared with people without pituitary adenomas, although this has been challenged by some.[19][87] One study reported on the QoL findings among 193 people with CNFPAs. The patients were evaluated with 3 validated health-related QoL questionnaires. Compared with healthy UK controls, patients with CNFPAs had a QoL and perception of subjective health that was not significantly compromised. In subgroup multivariate analysis the following factors were associated with significantly impaired scores on the QoL questionnaires: age, female sex, untreated hypogonadism, tumor recurrence, and the presence of visual field deficits.[88]
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