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  • Prognostic implication of size on outcomes of Pituitary Macroadenoma: a comparative analysis of Giant Adenoma with Non-giant Macroadenoma

    Final Number:

    Fauzan Alam Hashmi MBBS; Syed Ather Enam; Muhammad Bilal Tariq; Asra Tanwir

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: The authors aimed to differentiate giant pituitary adenomas from non-giant pituitary macroadenomas, distinguishing them based on the presenting complain, surgical procedures, tumor resections and recurrence.

    Methods: A retrospective analysis of pituitary macroadenomas that underwent surgical resection at Aga Khan University, Pakistan was done. Tumors were divided into two groups for comparison, tumors greater than 4 cm were classified as giant pituitary adenoma while macroadenomas smaller than 4 cm were termed as non-giant pituitary macroadenoma. Between 2006 and 2017, 75 patients had resection of giant pituitary adenoma. To match these cases, 75 patients with non-giant macroadenoma were chosen using non-probability sampling

    Results: The most common complaint of patients with non-giant pituitary macroadenoma were visual deterioration, reported by 77.3% of patients with non-giant pituitary macroadenoma and 89.3% with giant pituitary adenoma. The mean volume of the non-giant adenomas was 6.3ml (range 0.45ml-22ml) in contrast to giant pituitary adenomas with a mean volume of 30.1 ml (range 10.8 ml-149.4) (p=0.001). Microscopic transsphenoidal approach was the most commonly used procedure in both non-giant macroadenoma (49%) and GPA (44.8%). Tumor recurrence/progression was seen in 9.3% of patients with non-giant pituitary macroadenoma and 44% of patients with giant pituitary adenoma p=<0.001. The mean extent of resection was 88.9% for non-giant macroadenomas whereas the mean extent of resection was 76.7% for giant pituitary adenomas (p=0.03).

    Conclusions: When compared with non-giant macroadenoma, giant pituitary adenomas are more likely to present with a higher number of preoperative symptoms, lesser chances of tumor resection and postoperative symptoms. They are also associated with higher number of recurrence.

    Patient Care: Giant pituitary adenoma patients should be counselled before hand for a difficult course, surgeons should also be aware of the invasiveness of the tumor.

    Learning Objectives: Comparison of Giant Pituitary adenomas vs non-giant macroadenomas.


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