size and removal of pituitary adenoma

[CYJ]

I am a 30 year old female.  I have complained of headaches for a while off and on for about three years.  The first years it was diagnosed as migraines.  They eventually stopped and recently I suffered a headach like no other I have ever experienced.  I had an MRI done and was diagnosed with a non-functioning pituitary adenoma on the anterior that is 10mm.    I had an MRI done 1 year ago, and nothing was mentioned about an adenoma,   First question is 1cm considered large for a pituitary adenoma?    Next question, at that size is transsphenoidal removal still an option.  If so, what are some of the more serious side effects.  Is it likely the adenoma could have presented and grown a full 1cm inside of 1 year.

Thank you in advance.

[ouida167]

A related discussion, What shoul we do? was started.

[Aunesty]

Could you please update what has happened since you posted your question, as I am going through something similiar.  

Did you have your hormone levels  checked?  What were your results?  Were there any other glands involved with this tumor?  Did you have the surgery?  Are you going to have to have radiation treatment?

I am very interested in the exact symptoms you were experiencing and what blood work was performed prior to finding the tumor and what was performed after.

Please respond.

Thank you
Aunesty

[CCF-Neuro-M.D.-JT]

Pituitary adenomas less than 1 cm in size are referred to as microadenomas while those greater than 1 cm are macroadenomas. When you ask if it's considered large, you can think of it in two ways. Has it extended past the space invading other parts of the brain (which yours does not sound like)? Or you can think about it in terms of what kind of hormone the adenoma secretes and how to manage it.  Say for instance, you had a prolactinoma that was 1cm. Some studies say observation is appropriate for prolactinomas that are 5mm.  So with respect to conservative management, then it's large enough to think about surgery.You mentioned that it was non-functioning. If this was indeed proven by neuro-endocrinologic testing (which measures the different hormones in your body to see what's too high or too low) to be "non-secretory," then it's just like the prolactinoma. If it's just 5mm, then you can observe it with serial MRI's. But since it's 1cm, then you should think about surgery if it's big enough  to be pushing against parts of your brain and affecting their functions or extending upwards past its space in the brain.

The management of these tumors depends on its size and the histologic (tissue/function - meaning what it secretes) type. As long as large parts of your tumor have not extended into the extrasellar space, then transphenoidal surgery is still an option. There is usually A 5-10%complication rate with cerebrospinal fluid leak as the most common potential problem post-op. Other complications include vision loss and sinusitis. Injury to the carotid artery is uncommon, but can happen with big tumors. Also in the last decade, gamma knife or proton beam surgeries are being done to treat pituitary tumors in which a focused beam of radiation is used to shrink the adenoma without cutting you open. You'll have to talk to a neurosurgeon about the details of this procedure, but it may be an option for you.
And your last question: it's possible that it grew this fast w/in a year, but it's also possible that it was present but too small to be caught on the last MRI or just simply missed.Best of luck.