Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors

European Journal of Endocrinology
Ilan ShimonMarcello D Bronstein

Abstract

Patients with acromegaly usually harbor macroadenomas measuring between 10 and 30 mm in maximal diameter. Giant (adenoma size ≥40 mm) GH-secreting pituitary tumors are rarely encountered and the aim of this study is to analyze different methods for managing them. We have identified 34 patients (15 men and 19 females) with giant adenomas among 762 subjects (4.5%) with acromegaly in our records, and characterized their clinical characteristics and response to treatment. Mean age at diagnosis was 34.9±12.5 years (range, 16-67 years). Mean adenoma size was 49.4±9.4 mm (range, 40-80 mm); 30 adenomas showed cavernous sinus invasion and 32 had suprasellar extension. Twenty-nine (85%) patients had visual field defects. Mean baseline IGF1 was 3.4±1.8×ULN. All patients except one underwent pituitary surgery (one to three procedures), but none achieved hormonal remission following first surgery. Among the 28 subjects with visual disturbances, 14 recovered post-operatively and 13 improved. Treatment with somatostatin analogs was given to all patients after surgical failure. Six achieved remission, nine others were partially controlled (IGF1<1.5×ULN; 3/9 when combined with cabergoline), and 17 did not respond (two were lost). Nine patients ...Continue Reading

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Citations

Apr 10, 2016·World Neurosurgery·Chao-Hung KuoHenrich Cheng
Dec 18, 2016·Pituitary·Daniel A DonohoJohn D Carmichael
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Jun 28, 2019·European Endocrinology·Elena V VarlamovMaria Fleseriu
Nov 13, 2019·Clinical Endocrinology·Caroline HayhurstJohn Stephen Davies
Feb 18, 2020·Reviews in Endocrine & Metabolic Disorders·Frederic Castinetti
Jun 6, 2020·Reviews in Endocrine & Metabolic Disorders·Michael Buchfelder, Sven-Martin Schlaffer
Feb 18, 2017·Pituitary·Monica Livia Gheorghiu

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