EFFECT OF SURGERY AND RADIOTHERAPY ON VISUAL AND ENDOCRINE FUNCTION IN NONFUNCTIONING PITUITARY-ADENOMAS

The effect of surgery alone or followed by radiotherapy in recovering visual abnormalities, debulking tumor mass and restoring hormone impai rments was evaluated in 84 patients with clinically nonfunctioning pit uitary adenomas (NFPA) subjected to 1-10 yr follow-up. All patients un derwent surgery via transsphenoidal tin 69) or transcranic-pterional a pproach (in 15). Radiotherapy was performed after surgery in 59 of 72 patients with incomplete tumor removal. The assessment of pituitary fu nction was performed in all patients before and every 1-2 yr after sur gery and/or radiotherapy. Radiological and ophthalmologic assessment w as performed before and 3, 6 and 12 months after surgery, then yearly. At diagnosis, headache and visual disturbances occurred in 63 and 58 patients, respectively, while deficiency of GH, TSH, ACTH, FSH, LH and ADH was documented in 55, 7, 19, 47 and 6 patients, respectively. Aft er surgery, gonadal function recovered in 12 women, visual disturbance s improved in 43 patients (15 regained normal vision), pituitary funct ion improved in 8 of 62 patients, worsened in 34 patients. At MRI, com plete tumor removal was documented in 12 of 84 patients. After surgery alone, tumor regrowth was observed in 7 patients between 3-7 yr. Afte r radiotherapy, vision improved in 9, remained unchanged in 49 and wor sened in 1 of 59 patients. After radiotherapy, tumor regrowth was docu mented in 9 patients between 2-12 yr and the prevalence of hypopituita rism raised from 28.8% to 92% after 1 and 10 yr. In conclusion, surger y alone is effective only in a minority of patients (14.3%) and radiot herapy causes hypopituitarism in rather the totality of patients after 10 yr. The prevalence of tumor regrowth was similar in irradiated one s (15%) and non irradiated patients (28%; chi(2), p=0.4). Therefore, a careful radiological followup is suggested after surgery so that radi otherapy can be performed promptly on the basis of clinical data, tumo r regrowth and/or invasiveness documented at histology. (C) 1998, Edit rice Kurtis.