First German Guideline on Diagnostics and Therapy of Clinically Non-Functioning Pituitary Tumors

Author:

Deutschbein Timo12ORCID,Jaursch-Hancke Cornelia3,Knappe Ulrich J.4,Saeger Wolfgang5,Flitsch Jörg6,Bojunga Jörg7,Buchfelder Michael8,Ditzen Beate9,Gerlach Rüdiger10,Gertzen Elfriede11,Honegger Jürgen12,Horstmann Gerhard A.13,Koch Arend14,Kreitschmann-Andermahr Ilonka15ORCID,Kunz Mirjam16,Lagrèze Wolf A.17,Nicolay Nils H.18,Paulus Werner19,Reincke Martin20,Schmidt Manuel A.21,Weber Matthias M.22,Wilhelm Helmut23,Fassnacht Martin1

Affiliation:

1. Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Würzburg, Germany

2. Medicover Oldenburg MVZ, Oldenburg, Germany

3. Department of Endocrinology, German Clinic of Diagnostics, Wiesbaden, Germany

4. Department of Neurosurgery, Johannes Wesling Hospital, University Hospital of the Ruhr-University Bochum, Minden, Germany

5. Institute for Neuropathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

6. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

7. Department of Internal Medicine I, Division of Endocrinology, Goethe-University Hospital, Frankfurt, Germany

8. Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany

9. Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls University Heidelberg, Heidelberg, Germany

10. Department of Neurosurgery, Helios Klinikum Erfurt, Erfurt, Germany

11. Niels Stensen Bildungszentrum, Osnabrück, Germany

12. Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Germany

13. Gamma Knife Center Krefeld, Krefeld, Germany

14. Department of Neuropathology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany

15. Department of Neurosurgery and Spine Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany

16. Schwerpunktpraxis für Diabetologie und Endokrinologie, Ludwigshafen, Germany

17. Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany

18. Department of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, Germany

19. Institute of Neuropathology, University Hospital Münster, Münster, Germany

20. Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, München, Germany

21. Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

22. Department of Endocrinology and Metabolism, I Medical Clinic, University Hospital, Johannes Gutenberg University of Mainz, Mainz, Germany

23. Centre for Ophthalmology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany

Abstract

AbstractAlthough non-functioning pituitary tumors are frequent, diagnostic and therapeutic concepts are not well standardized. We here present the first German multidisciplinary guideline on this topic. The single most important message is to manage the patients by a multidisciplinary team (consisting at least of an endocrinologist, a neurosurgeon, and a (neuro-) radiologist). The initial diagnostic work-up comprises a detailed characterization of both biochemical (focusing on hormonal excess or deficiency states) and morphological aspects (with magnetic resonance imaging of the sellar region). An ophthalmological examination is only needed in presence of symptoms or large tumors affecting the visual system. Asymptomatic, hormonally inactive tumors allow for a 'wait and scan' strategy. In contrast, surgical treatment by an experienced pituitary surgeon is standard of care in case of (impending) visual impairment. Therapeutic options for incompletely resected or recurrent tumors include re-operation, radiotherapy, and observation; the individual treatment plan should be developed multidisciplinary. Irrespective of the therapeutic approach applied, patients require long-term follow-up. Patient with larger pituitary tumors or former surgery/radiotherapy should be regularly counseled regarding potential symptoms of hormonal deficiency states.

Publisher

Georg Thieme Verlag KG

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism,Internal Medicine

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