Download - Residual Non-Funtioning Pituitary Adenoma
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Ahmad M. Badran
Andrew S. Davidson
13 April 2017
TREAT NOW, OR LATER…
Residual Non-Functioning Pituitary Adenoma
• 37 yr old man presented with:
Headache (2/52)
Poor libido, reduced body hair, & infertility (12/12)
• Visual exam: Normal.
• Pituitary function test:
Testosterone 4.0
Otherwise NL
Case Presentation
Macquarie Neurosurgery 2
Macquarie Neurosurgery 3
Macquarie Neurosurgery 4
Residual pituitary
adenoma within the
Rt. cavernous sinus.
Stable over 18/12.
P – Patient with residual non-functioning pituitary adenoma post surgical debulking.
I – Gamma Knife Surgery.
C – Observation.
O – Time to tumour progression.
Question: When should we treat? now, or later?
Searchable Question (PICO)
Macquarie Neurosurgery 5
• Search for all studies that could provide data on gamma
knife surgery for residual pituitary adenoma
• Search Medline, Embase, and Scopus.
• Include case series and cohort studies.
• Exclude case reports.
Search Strategy
Macquarie Neurosurgery 6
Macquarie Neurosurgery 7
MEDLINE SEARCH
Macquarie Neurosurgery 8
EMBASE SEARCH
Macquarie Neurosurgery 9
SCOPUS SEARCH
Prisma
Macquarie Neurosurgery 10
Medline 81 Embase 34 Others 2
Total papers 151
(78 Duplicates)
Abstracts reviewed 34
Excluded 6
Articles retrieved 9
Excluded 25
Excluded 117
Articles reviewed 3
Scopus 112
Results
Macquarie Neurosurgery 11
Authors Year Journal Instit-
utions
Study Design No. Classifica-
tion
Tx. Follow
Up
Progress-
ion
RRIED RRIONI
Chen
et al
2012 Neuro-
endocrinology
China Systematic
Review
971 5 yrs
10 yrs
Nil 5 yrs
10 yrs
29%
41%
N/A N/A
Chen & Li
et al
2013 European
Journal of
Endocrinology
China Systematic
Review
925 < 2 ml
2-4 ml
> 4 ml
GKS 5-10
yrs
1%
4%
9%
1%
7%
22%
1%
0%
2%
Pomeraniec
et al
2016 Journal of
Neurosurgery
USA Retrospective
Cohort
64 < 6 m
> 6 m
GKS 4.8 yr
7 yr
6.3%
28.1%
16.7%
63.6%
N/A
Conclusions
Residual adenoma is likely to progress slowly over time with a tumourvolume doubling time (TVDT) in a few years.
Gamma knife surgery is effective in controlling progression of residual non-functioning pituitary adenoma.
The rate of radiosurgery induced endocrine deficit (RRIED) is higher when the residual tumour volume is larger.
The rate of radiosurgery induced optic neuropathy injury (RRIONI) is low.
Close follow-up and timely intervention is a reasonable choice for known residual post-op NFAs.
For large residual NFPAs, surgery is recommended to reduce residual tumour volume +/- GKS.Macquarie Neurosurgery 12