Pituitary Adenoma Incidence,Management Trends,and Long-term Outcomes: A 30-Year Population-Based Analysis |
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| Affiliation: | 1. Department of Neurologic Surgery, Mayo Clinic, Rochester MN;2. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester MN;3. Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester MN;4. Department of Radiation Oncology, Mayo Clinic, Rochester MN;5. Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN;1. Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA;2. Kaiser Permanente Center for Health Research, Portland, OR;3. Oregon Health and Science University, Portland, OR;1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Weill Cornell Breast Center, Department of Surgery, Weill Cornell Medicine, New York, NY, USA;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN;2. Advisor to residents and Consultant in Cardiovascular Medicine, Mayo Clinic, Rochester, MN;1. Providence Medical Research Center, Providence Health Care, University of Washington, Spokane and Seattle;2. David Geffen School of Medicine at University of California, Los Angeles;1. Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France;2. Lyon immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France;3. Service de pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France;4. Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France;5. Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France;6. Service de court séjour gériatrique, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France;7. Université de Lyon, Université Lyon 1, Health Services and Performance Research EA7425, Lyon, France;8. Service de médecine interne et d’immunologie clinique, CHU Dijon Bourgogne, Hôpital François Mitterrand, Dijon, France;1. Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt;2. Zagazig University Hospitals, Zagazig, El-Sharkia, Egypt;3. Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland;4. Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland;5. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School–The University of Queensland School of Medicine, New Orleans, Louisiana;6. Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland |
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| Abstract: | ObjectiveTo perform a population-based study of pituitary adenoma epidemiology, including longitudinal trends in disease incidence, treatment patterns, and outcomes.Patients and MethodsIn this study of incident pituitary adenomas in Olmsted County, Minnesota, from January 1, 1989, through December 31, 2019, we identified 785 patients who underwent primary screening, 435 of whom were confirmed as harboring incident pituitary adenomas and were included. Primary outcomes of interest included demographic characteristics, presenting features, and disease outcomes (tumor control, biochemical control, and complications).ResultsAmong our 435 study patients, 438 unique pituitary adenomas were diagnosed at a median patient age of 39 years (interquartile range [IQR], 27 to 58 years). Adenomas were incidentally identified in 164 of the 438 tumors (37%). Common symptomatic presentations included hyperprolactinemia (188 of 438 [43%]) and visual field deficit (47 of 438 [11%]). Laboratory tests confirmed pituitary hormone hypersecretion in 238 of the 435 patients (55%), which was symptomatic in 222. The median tumor diameter was 8 mm (IQR, 5 to 17 mm). Primary management strategies were observation (156 of 438 tumors [36%]), medication (162 of 438 tumors [37%]), and transsphenoidal resection (120 of 438 tumors [27%]). Tumor and biochemical control were achieved in 398 (95%) and 216 (91%) secreting tumors, respectively. New posttreatment pituitary or visual deficits were noted in 43 (11%) and 8 (2%); apoplexy occurred in 28 (6%). Median clinical follow-up was 98 months (IQR, 47 to 189 months). Standardized incidence rates were 3.77 to 16.87 per 100,000 population, demonstrating linear expansion over time (R2=0.67). The mean overall standardized incidence rate was 10.1 per 100,000 population; final point prevalence was 175.1 per 100,000 population.ConclusionPituitary adenoma is a highly incident disease, with prolactin-secreting and incidental lesions representing the majority of tumors. Incidence rates and asymptomatic detection appear to be increasing over time. Presenting symptoms and treatment pathways are variable; however, most patients achieve favorable outcomes with observation or a single treatment modality. |
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