Abstract
Introduction: Pituitary adenoma has not been widely studied using population-based epidemiologic techniques. The goal of the current study was to perform a population-based study of pituitary adenoma epidemiology, including longitudinal trends in disease incidence, treatment patterns, and outcomes. Methods: Population-based study of incident pituitary adenomas in Olmsted, MN, 1989–2019. Observation and all treatment modalities, including operative intervention, radiotherapy, and medications, were assessed. Primary outcomes of interest included demographics (age, sex), presenting features (symptoms, lesion size, hormonal status), treatment history, and disease outcomes (tumor control, biochemical control, and complications). Results: A total of 438 unique pituitary adenomas were diagnosed at a median 39 years (IQR = 27–58). Adenomas were incidentally identified in 164 (37%). Common symptomatic presentations included hyperprolactinemia (n = 188, 43%) and visual field deficit (n = 47, 11%). Median diameter was 8 mm (IQR = 5–17). Hormone hypersecretion occurred in 238 (55%), of whom 16 (4%) were asymptomatic. Primary management strategies were observation (n = 156, 36%), medication (n = 162, 37%), and transsphenoidal resection (n = 120, 27%). Multiple interventions were required in 57 (14%); 15 patients failed all treatments (4%). Tumor control was achieved in 398 (95%); biochemical control was achieved in 216 secreting tumors (91%). New posttreatment pituitary or visual deficits were noted in 45 (11%) and 8 (2%); apoplexy occurred in 28 (6%). Median clinical follow-up was 98 months (IQR = 47–189). Standardized incidence rates were 3.77–16.87/100,000, demonstrating linear expansion over time (R 2 = 0.67) that was not accounted for by the increasing fraction of incidental diagnosis. Mean overall SIR was 10.1/100,000; final point prevalence was 175.1/100,000. Conclusion and Relevance: Pituitary adenoma is a highly incident disease, with prolactin-secreting and incidental lesions accounting for 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 front-line intervention ([Figs. 1] and [2]; [Tables 1] and [2]). Publication Date: 15 February 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany