Pituitary Macroadenoma
Summary
In this on-demand teaching session, professionals from "Iuliu Hațieganu" University of Medicine and Pharmacy discuss the critical role of a multidisciplinary approach in managing non-functioning pituitary adenomas (NFPAs), using a case study of a 64-year-old female patient. The session illustrates the complexity of NFPA management through postoperative and 12-month follow-up results, highlighting the impact on a patient's endocrine profile and the necessity for coordinated care between specialties. It emphasizes the interaction between endocrinology, ophthalmology, neurosurgery, and neurology for managing complications, correcting pituitary insufficiency, and preventing recurrences. This course will provide valuable insights into dealing with invasive and recurrent medical conditions such as NFPAs.
Learning objectives
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Understand the clinical presentation and diagnostic findings of Non-functioning Pituitary Adenomas (NFPAs), with a specific focus on Pituitary Macroadenoma.
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Analyze and interpret the hormonal profile of a patient with Pituitary Macroadenoma preoperatively, postoperatively, and at 12-month follow-up.
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Identify the role of different medical specialties in the management of Pituitary Macroadenomas and appreciate the importance of a multidisciplinary approach.
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Recognize the complexities and potential complications associated with the surgical intervention of Pituitary Macroadenomas, such as Transsphenoidal Adenomectomy.
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Comprehend the need for postoperative treatment and interventions to correct pituitary insufficiency and prevent recurrence, including the use of hormonal replacement therapy.
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Pituitary Macroadenoma: A Multidisciplinary Approach Author: Cezara Pop¹ Co-author: Aniela Popescu¹, Ioana-Daria Pavăl¹, Iulia-Cezara Pop¹, Răzvan-Gabriel Pantilie¹, Albert Petre¹, Sebastian Romeo Pintilie¹ Coordinator: Dr. Ana Valea¹² ¹Affiliation: "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca ²Affiliation: Cluj-Napoca County Emergency Clinical Hospital – Endocrinology Clinic Introduction Non-functioning pituitary adenomas (NFPAs) account for one-third of pituitary adenomas and manifest with headaches, visual impairments, and hypopituitarism. Their invasive potential and high recurrence rate necessitate coordinated multidisciplinary management. Hormone Preoperative 1-Month 12-Month Postoperative Follow-up Case Presentation 64-year-old female TSH (µIU/ml) 1.59 0.85 1.10 Symptoms FT4 (ng/dl) 0.61 0.93 0.95 frontal headache diplopia visual field narrowing FSH (U/L) 10.5 8.57 10.1 Ophthalmologic exam LH (U/L) 1.6 3.25 2.60 Perimetry: bitemporal hemianopsia PRL (ng/ml) 24.4 3.57 22.9 Fig 1. Endocrine Profile: Preoperative, Postoperative, and 12-Month Follow-up Surgery Transsphenoidal adenomectomy Histopathology Non-functioning pituitary adenoma Post-op status Persistent cavernous sinus invasion Internal carotid artery encasement Treatment Thyroid replacement: Euthyrox Hyperprolactinemia: Dostinex Fig. 2: Contrast-Enhanced PituitarFig. 3: Contrast-Enhanced Pituitary MRI: Sellar and suprasellar macroadenomTumor growth, 12-month follow-up (40×26×36 mm) (34×26×30 mm ) Diagnosis non-functioning pituitary macroadenoma thyro-gonadal pituitary insufficiency optochiasmatic syndrome hypothalamic hyperprolactinemia Discussions References This case highlights the complexity of NFPA management, which extends beyond surgical intervention. A multidisciplinary approach involving endocrinology, ophthalmology, neurosurgery, and neurology, is essential for managing complications, correcting pituitary insufficiency, and preventing recurrences .