Pituitary Adenomas: Analysis Of The Clinical Features And Treatment Modalities Of 1060 Patients From 1996 To 2006 In West China Hospital

BACKGROUND&OBJECTIVE Pituitary adenomas represent 10-15%of all intracranial tumors. In adults, it is the leading cause which results inhypersecretion or hyposecretion of the anterior pituitary gland. The masseffect,the serial hormonal dysfunction, in addition to the complications ofsurgery impair the quality of life significantly, even can threaten the patients'lives. Therefore, it is important to make a proper diagnosis and choose apreferred treatment modality. Until now, the reports of large cases diagnosedas pituitary adenoma in our hospital are not available, so we design this studyto analyse the clinical features in different types of pituitary adenoma, take alook back at the treatment modalities during the past 11 years and discuss theprinciples in the choice of treatment.MATERIALS & METHODS From 1996 January to 2006 August,1060 cases of pituitary adenomas were diagnosed and treated in West ChinaHospital. Based on the clinical symptoms and signs associated with theendocrine evaluation, we classify these cases into 5 groups in terms of tumorfunction as follows: (1)Nonfunctioning adenoma(NFA); (2)PRL-secretingadenoma; (3) GH-secreting adenoma; (4) ACTH-secreting adenoma; (5)TSH-secreting adenoma. We aim to conclude the characteristics in theaspects of symptoms and signs, CT/MRI images, hormonal tests andpathological results. Besides, we classify these cases again into 6 groups according to the treatment modality as follows: (1)no further treatment; (2)single transcranial surgery; (3) single transsphenoidal surgery; (4) stereotacticradiosurgery; (5) multiple surgeries; (6) combined treatment. For thisclassification, we analyse the patients' characteristics in different groups andthe choice of diverse treatments.RESULTS There were 476 male patients and 584 female patients. Ofmicroadenomas, PRL-secreting adenomas accounted for 65.0%, which wasthe most common type in this group. While nonfunctioning adenomas wasthe most common type in both macroadenomas and giant macroadenomas,accounted for 61.5% and 73.5%, respectively. The tumor size innonfunctioning adenomas,PRL-secreting adenomas and GH-secretingadenomas was mostly macroadenoma, represented 77.8%,51.5% and 75.4%of the respective groups. In the other 2 groups, that is ACTH-secretingadenomas and TSH-secreting adenomas, we found microadenoma took thefirst place, accounted for 82.4% in the former, all 2 cases of the latter weremicroadenomas. There were 53.1% patients with nonfunctioning adenomas,31.3% with PRL-secreting adenomas, 12.0% with GH-secreting adenomas,3.4% with ACTH-secreting adenomas, and 0.2% with TSH-secretingadenomas. Considering the treatment modalities based on the tumor size,most patients(80.7%) with microadenomas received stereotactic radiosurgery,while single trancranial surgery was mostly adopted in treatingmacroadenomas(60.7%) and giant macroadenomas(78.0%).Single trancranialsurgery was still the most common modality in treating nonfunctioningadenomas(62.7%) and GH-secreting adenomas(53.4%), stereotacticradiosurgery was applied to treat most PRL-secreting adenomas(42.0%) andACTH-secreting adenomas(57.6%).CONCLUSION Surgery is the preferred treatment modality. However,the transcranial route is selected rather than the transsphenoidal route in our hospital. As the development of stereotactic radiosurgery is booming indomestic hospitals, more and more patients with microadenomas would liketo receive stereotactic radiosurgery as the first choice of treatment. Inaddition, stereotactic radiosurgery as an adjuvant treatment after surgery iswidely applied and accepted, it has taken the place of the conventionalradiotherapy in the choice of post-surgery treatment.