Asymptomatic large pituitary adenomas discovered at autopsy.

Background: Pituitary adenomas over 1 inch (2.5 cm) in diameter might seem to warrant surgical intervention by virtue of their inevitable compression and distortion of surrounding neural tissues.

Methods: We report three pituitary adenomas over 1 inch in diameter, causing gross distortion of the optic nerves, chiasm, and tracts, as well as surrounding brain structures. All three tumors were asymptomatic and were discovered incidentally at autopsy in patients 65, 79, and 101 years of age.

Results: Tumor diameters were 2.5, 4.0, and 2.5 cm, respectively. Histologically, all were chromophobe adenomas, free of either hemorrhage or necrosis. In the absence of hormonal secretion or pituitary apoplexy, symptom-free giant adenomas of the pituitary are compatible with a long life.

Conclusions: We conclude that the need for surgical intervention in pituitary adenomata should be determined by considerations other than mere tumor presence and size.