Suggested Algorithm for the Management of Patients with NFPAs - Flowchart

Suggested Algorithm for the Management of Patients with NFPAs - Flowchart

Suggested Algorithm for the Management of Patients with NFPAs - Flowchart Pituitary Adenoma Pituitary Adenoma

«Flowchart»

NFPA
Visual field defect and/or compression of optic pathways

NFPA
Visual field defect and/or compression of optic pathways

NFPA
Visual field defect and/or compression of optic pathways

NFPA

Yes

Yes

Yes

No

No

No

Surgery

Surgery

Surgery

MRI yearly for 3 yr, then less frequent

MRI yearly for 3 yr, then less frequent

MRI yearly for 3 yr, then less frequent

Microadenoma

Microadenoma

Microadenoma

Macroadenoma

Macroadenoma

Macroadenoma

Tumor growth/new pituitary deficit

Tumor growth/new pituitary deficit

Tumor growth/new pituitary deficit

Consider surgery

Consider surgery

Consider surgery

End

End

End

MRI in 6 mo then yearly for 3 yr, less frequent thereafter

MRI in 6 mo then yearly for 3 yr, less frequent thereafter

MRI in 6 mo then yearly for 3 yr, less frequent thereafter

>2 cm/abutting the chiasm/hypopituitarism

>2 cm/abutting the chiasm/hypopituitarism

>2 cm/abutting the chiasm/hypopituitarism

Yes

Yes

Yes

No

No

No

Tumor growth/visual field defect/new pituitary deficit

Tumor growth/visual field defect/new pituitary deficit

Tumor growth/visual field defect/new pituitary deficit

Follow-up

Follow-up

Follow-up

MRI 3–6 mo after surgery

MRI 3–6 mo after surgery

MRI 3–6 mo after surgery

No residual tumor

No residual tumor

No residual tumor

Residual tumor

Residual tumor

Residual tumor

Evident tumor growth/new visual defect

Evident tumor growth/new visual defect

Evident tumor growth/new visual defect

Consider surgery and/or RT

Consider surgery and/or RT

Consider surgery and/or RT

Non-controlled growth

Non-controlled growth

Non-controlled growth

Consider temozolomide

Consider temozolomide

Consider temozolomide

Individualized (follow-up, CAB, RT)

Individualized (follow-up, CAB, RT)

Individualized (follow-up, CAB, RT)

Small

Small

Small

Extrasellar/aggressive features

Extrasellar/aggressive features

Extrasellar/aggressive features

Progressive growth / new visual defect

Progressive growth / new visual defect

Progressive growth / new visual defect