Treatment of gonadotroph and other clinically nonfunctioning adenomas
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
Gonadotroph adenomas are the most common pituitary macroadenomas, comprising about 80 percent of clinically nonfunctioning adenomas. These adenomas are difficult to identify because their secretory products usually do not cause a recognizable clinical syndrome and because they often secrete so inefficiently that serum concentrations of intact gonadotropins and their subunits are often only minimally abnormal or not abnormal at all. Consequently, they are typically not detected until they become sufficiently large to cause neurologic symptoms, most often impaired vision due to pressure on the optic chiasm. Clinically nonfunctioning or “silent” somatotroph and corticotroph adenomas are also being identified with increasing frequency.
The treatment of gonadotroph and other clinically nonfunctioning adenomas will be reviewed here. Their clinical manifestations and diagnosis are discussed separately. (See "Clinical manifestations and diagnosis of gonadotroph and other clinically nonfunctioning pituitary adenomas".)
Overview — Gonadotroph or other nonfunctioning macroadenomas are typically diagnosed when they become large enough to cause neurologic symptoms (eg, headaches, visual loss), a hormonal deficiency state, when an imaging study is performed for unrelated reasons, or less commonly, because of hormonal hypersecretion.
Once identified, treatment should be promptly instituted for those with impaired vision, and considered for those at high risk for loss of vision (marked suprasellar tumor extension). Standard first-line therapy is transsphenoidal surgery. If there is no or little discernible residual adenoma tissue by magnetic resonance imaging (MRI), the patient should be monitored by MRI and hormonally, initially at six-month intervals. If there is considerable residual adenomatous tissue, radiation should be administered. Long-term monitoring is necessary because the risk of tumor regrowth is significant, particularly after surgery alone. Life-long management of pituitary hormone deficiencies is required in many patients. (See 'Adjuvant radiation therapy' below and 'Hormonal abnormalities' below.)
Goals of treatment — The goals of treatment in patients with gonadotroph or nonfunctioning adenomas include:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- MANAGEMENT APPROACH
- Goals of treatment
- Surgical approach
- - Preoperative preparation
- - Choice of procedure
- - Perioperative management
- Diabetes insipidus and SIADH
- - Short-term monitoring
- - Outcomes
- Residual adenoma
- Visual function
- Hormonal abnormalities
- Adjuvant radiation therapy
- - "Conventional" radiation therapy
- - Stereotactic radiation
- Unproven therapies
- Long-term follow-up
- - Adenoma regrowth
- - Quality of life
- ASYMPTOMATIC ADENOMAS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS