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The chronic syndromes after previous treatment of pituitary tumours

Nature Reviews Endocrinology volume 12, pages 547–556 (2016)Cite this article

Subjects

Key Points

  • Many patients previously treated for pituitary tumours have chronic, multisystem morbidity in addition to hypopituitarism

  • Many patients previously treated for pituitary tumours with visual-field defects have hypothalamic dysfunction that is associated with morbidity and mortality

  • Many patients appropriately treated for acromegaly have chronic morbidity owing to irreversible effects of previous excess of growth hormone and insulin-like growth factor 1

  • Many patients adequately treated for Cushing disease have morbidity and an increased risk of death owing to irreversible effects of previous cortisol excess

Abstract

Ultimately, almost all patients who are appropriately treated for pituitary tumours enter a chronic phase with control or cure of hormonal excess, adequate treatment of pituitary insufficiency and relief of mass effects. This phase is associated with improvement of initial signs and symptoms, but also with the persistent consequences of the initial disease and associated treatments. Pituitary insufficiency is a common denominator in many of these patients, and is associated with a reduction in quality of life, despite adequate endocrine substitution. Hypothalamic dysfunction can be present in patients previously treated for visual impairments caused by large suprasellar adenomas, or craniopharyngiomas. In addition to hypopituitarism, these patients can have multisystem morbidities caused by altered hypothalamic function, including weight gain and disturbed regulation of sleep–wake cycles. Mortality can also be affected. Patients cured of Cushing disease or acromegaly have chronic multisystem morbidities (in the case of Cushing disease, also affecting mortality) caused by irreversible effects of the previous excesses of cortisol in Cushing disease and growth hormone and insulin-like growth factor 1 in acromegaly. In addition to early diagnosis and treatment of pituitary tumours, research should focus on the amenability of these chronic post-treatment syndromes to therapeutic intervention, to improve quality of life and clinical outcomes.

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Figure 1: Different chronic syndromes during long-term follow-up of patients treated for pituitary tumours.

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    Johannes A. Romijn

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Romijn, J. The chronic syndromes after previous treatment of pituitary tumours. Nat Rev Endocrinol 12, 547–556 (2016). https://doi.org/10.1038/nrendo.2016.84

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