Risk factors of recurrent non-functioning pituitary adenomas in patients with growth hormone deficiency
Background. Nowadays, a search for diagnostically significant markers of aggressiveness of nonfunctioning pituitary adenomas remains relevant for further prognosis in the postoperative period. Nonfunctioning pituitary adenomas without pituitary hypersecretion are the forms of adenohypophysis tumors. In the general population, frequency of nonfunctioning pituitary adenomas is 50 cases per 1 million people. The purpose of the study is to determine the clinical diagnostic markers of tumor aggressiveness in patients with nonfunctioning pituitary adenomas and growth hormone deficiency, as well as their role in the severity of the neuroendocrine symptoms of the disease. Materials and methods. Under our supervision, there were 87 patients (44 men, 43 women), of them 31 with a verified diagnosis of nonfunctioning pituitary adenomas after transnasal hypophysectomy. Followup was from 1 to 3 years. Results. When patients were distributed in groups depending on histological description of nonfunctioning pituitary adenomas, those with chromophobe pituitary adenoma prevailed (77.5 %). Nonfunctioning pituitary adenomas in women were associated with obesity, primary and secondary hypothyroidism, secondary hypogonadism, syndrome of persistent galactorrheaamenorrhea (symptomatic and idiopathic forms), diabetes insipidus, empty sella syndrome and others. In men, nonfunctioning pituitary adenomas was accompanied by obesity, primary and secondary hypothyroidism, secondary hypogonadism, diabetes insipidus, gynecomastia. The scale developed to determine the markers of aggressiveness of nonfunctioning pituitary adenomas allowed identifying factors by 3 degrees and developing a set of measures to prevent the recurrence of tumor growth. Conclusions. Markers of aggressiveness of nonfunctioning pituitary adenomas are: young age of the patient, first symptoms of the disease, large tumor sizes, asymmetry and deformation of the pituitary gland, signs of tumor invasion into adjacent tissues/arteries/cavernous sinus, small cell and/or dark cell chromophobe adenomas, panhypopituitarism.
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