NON-FUNCTIONING PITUITARY ADENOMAS : A PLEA FOR AN EARLIER DIAGNOSIS

Introduction Clinically silent pituitary adenomas are not diagnosed because of hormonal hypersecretion. They are detected late when the optic pathway is compressed. The objective of this work is to define clinical and biological profile which will allow an early diagnosis. Material and methods 44 files of patients operated on between 1994 and 2005 were analyzed. They all had macroadenomas of different histochemical types. Sex, gynecological and obstetrical history, age, delay before diagnosis, circumstances of diagnosis and clinical data were obtained in each case. Basic gonadotrophins level, GnRH and TRH dynamical tests were separately performed in men, sexually active women and women in menopause. Histopathology and immunohistochemistry studies were performed. Results the series comprised 28 men(63.6%) and 16 women (36.4%) (10 of them were in menopause). Mean age was 58.5 years and diagnostic delay was 9.5 months. Tumoral syndrome was present in 86.4 % of cases, all the patients had visual impairment, mainly visual's field amputation or restriction. Hypopituitarism syndrome was present (41 %) according to the degree of compression or destruction of the normal pituitary gland by the tumor, except for gonadotrophic hypersecretion signs (9.1%). Hormonal dosage showed more than 60% of pituitary gland insufficiency in all three groups, particularly the gonadotrophic one. Moderate prolactin hypersecretion was found in 41 to 89% of cases, but the absolute value was always less than 150 ng/ml At histoimmunochemistry, gonadotroph cell adenomas predominate (81.8%), followed by the real non-secreting one(11%), then corticotroph (4.5%) and lastly the multi-secreting adenomas (2.3%) Conclusion The clinical syndrome of non secretory pituitary adenoma is not clearly defined. Practitionners need to identify early these symptoms, which were actually present from the beginning of the clinical history, by a meticulous examination. If patient presents cephalalgia and visual impairment, cerebral CT scan or MRI explorations are mandatory to explore the presence of a pituitary tumor. In case of non-functioning pituitary adenoma, basic endocrine exploration should find a hypopituitarism, mainly gonadotropic, with a moderate prolactin hypersecretion. The dosage of a and beta ubunits must be done. Dynamic tests should be performed only in case of difficulty. Analysis is difficult in menopausal women