The Psychosocial and Economic Burden of Pituitary Adenomas: Implications for Community Health and Healthcare Systems

Background: Pituitary adenomas are among the most frequently encountered intracranial tumors, yet their psychosocial and economic consequences remain under-recognized; clinically recognized adenomas must also be distinguished from incidental lesions identified at autopsy or imaging. Objective: This narrative review synthesizes evidence concerning the psychosocial burden, quality of life, healthcare utilization, economic impact, and community-health implications of pituitary adenomas, with particular attention to resource-constrained settings. Methods: A narrative review with a structured literature search was conducted. Peer-reviewed literature published between January 2004 and December 2020 was identified through searches of PubMed, Scopus, Google Scholar, and the Directory of Open Access Journals, and evidence was synthesized narratively and thematically. Results: Included studies consistently reported substantial psychosocial distress, reduced health-related quality of life, work impairment, caregiver burden, and high healthcare utilization; however, reported magnitude varied by tumor type, disease activity, treatment status, measurement instruments, and study setting, with the highest psychosocial burden observed in Cushing disease and acromegaly. Most formal economic estimates were derived from high-income healthcare systems and should not be directly extrapolated to low- and middle-income countries, where the literature more often describes contextual burdens such as delayed diagnosis, out-of-pocket expenditure, and limited access to specialist care. Conclusion: The available evidence supports improved clinical awareness, timely recognition of suggestive symptoms, targeted hormonal evaluation, appropriate referral pathways, and improved access to specialist endocrine and neurosurgical services. Such integrated, multidisciplinary care may reduce avoidable morbidity and potentially lessen long-term health-system burden, although context-specific economic and community-health research from low- and middle-income countries is needed.

Pituitary Neoplasms; Quality of Life; Mental Health; Health Care Costs; Community Health Services

1. Daly, A. F., & Beckers, A. (2020). The epidemiology of pituitary adenomas. Endocrinology and Metabolism Clinics of North America, 49(3), 347–355. https://doi.org/10.1016/j.ecl.2020.02.002 [Google Scholar] [Crossref]

2. Ezzat, S., Asa, S. L., Couldwell, W. T., et al. (2004). The prevalence of pituitary adenomas: A systematic review. Cancer, 101(3), 613–619. https://doi.org/10.1002/cncr.20442 [Google Scholar] [Crossref]

3. Jacob, M., Raverot, G., Jouanneau, E., & Borson-Chazot, F. (2017). Pituitary adenomas: A hidden threat. Reviews in Endocrine and Metabolic Disorders, 18(3), 275–284. https://doi.org/10.1007/s11154-017-9417-8 [Google Scholar] [Crossref]

4. Asa, S. L., Mete, O., Perry, A., & Osamura, R. Y. (2022). Overview of the 2022 WHO classification of pituitary tumors. Endocrine Pathology, 33(1), 6–26. https://doi.org/10.1007/s12022-022-09703-7 [Google Scholar] [Crossref]

5. Asa, S. L., Casar-Borota, O., Chanson, P., et al. (2017). From pituitary adenoma to pituitary neuroendocrine tumor (PitNET): An International Pituitary Pathology Club proposal. Endocrine-Related Cancer, 24(4), C5–C8. https://doi.org/10.1530/ERC-17-0004 [Google Scholar] [Crossref]

6. Melmed, S. (2011). Pathogenesis of pituitary tumors. Nature Reviews Endocrinology, 7(5), 257–266. https://doi.org/10.1038/nrendo.2011.32 [Google Scholar] [Crossref]

7. Pivonello, R., De Martino, M. C., & Koide, Y. (2015). Cushing disease: The burden of illness. Endocrine, 50(1), 1–10. https://doi.org/10.1007/s12020-015-0578-6 [Google Scholar] [Crossref]

8. Molitch, M. E. (2017). Diagnosis and treatment of pituitary adenomas: A review. JAMA, 317(5), 516–524. https://doi.org/10.1001/jama.2016.19690 [Google Scholar] [Crossref]

9. Fitzgerald, P. A., Tesfaye, M., & Miller, G. (2015). Psychosocial aspects of pituitary disease: A review. Pituitary, 18(6), 846–853. https://doi.org/10.1007/s11102-015-0645-2 [Google Scholar] [Crossref]

10. Kreitschmann-Andermahr, I., Psaras, T., & Tsiogka, M. (2014). Quality of life and psychosocial burden in patients with pituitary adenomas. Current Opinion in Endocrinology, Diabetes and Obesity, 21(4), 296–303. https://doi.org/10.1097/MED.0000000000000088 [Google Scholar] [Crossref]

11. Zhao, Y. J., Wang, Z. Y., & Xu, J. (2010). Delayed diagnosis of pituitary adenomas: Analysis of causes and consequences. Journal of Neuro-Oncology, 96(3), 435–441. https://doi.org/10.1007/s11060-009-9980-2 [Google Scholar] [Crossref]

12. Freda, P. U., Beckers, A. M., Katznelson, L., et al. (2011). Pituitary incidentaloma: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 96(4), 894–904. https://doi.org/10.1210/jc.2010-2218 [Google Scholar] [Crossref]

13. Sisco, J., & van der Lely, A. J. (2021). Towards an earlier diagnosis of acromegaly and gigantism. Journal of Clinical Medicine, 10(7), 1363. https://doi.org/10.3390/jcm10071363 [Google Scholar] [Crossref]

14. Rubinstein, G., et al. (2020). Time to diagnosis in Cushing’s syndrome: A meta-analysis based on 5367 patients. Journal of Clinical Endocrinology and Metabolism, 105(3). [Google Scholar] [Crossref]

15. https://doi.org/10.1210/clinem/dgz136 [Google Scholar] [Crossref]

16. Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4(1), 5. https://doi.org/10.1186/s41073-019-0064-8 [Google Scholar] [Crossref]

17. Castle-Kirszbaum, M., Biermasz, N., Kam, J., & Goldschlager, T. (2024). Quality of life in prolactinoma: A systematic review. Pituitary, 27(3), 239–247. https://doi.org/10.1007/s11102-024-01392-1 [Google Scholar] [Crossref]

18. van der Meulen, M., Zamanipoor Najafabadi, A. H., Broersen, L. H. A., et al. (2022). State of the art of patient-reported outcomes in acromegaly or GH deficiency: A systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism, 107(5), 1225–1238. [Google Scholar] [Crossref]

19. https://doi.org/10.1210/clinem/dqab874 [Google Scholar] [Crossref]

20. Wang, W., Yang, T., & Huang, Q. (2024). Quality of life in patients with acromegaly: A scoping review. Orphanet Journal of Rare Diseases, 19. https://doi.org/10.1186/s13023-024-03246-2 [Google Scholar] [Crossref]

21. Moon, S., Hong, S., Han, K., & Park, C. Y. (2023). Risk of depression in patients with acromegaly in Korea (2006–2016): A nationwide population-based study. European Journal of Endocrinology, 189(3), 363–371. https://doi.org/10.1093/ejendo/lvad120 [Google Scholar] [Crossref]

22. Chanson, P., & Salenave, S. (2008). Acromegaly. Orphanet Journal of Rare Diseases, 3(1), 17. [Google Scholar] [Crossref]

23. https://doi.org/10.1186/1750-1172-3-17 [Google Scholar] [Crossref]

24. Santos, A., Resmini, E., & Martinez-Momblan, M. A. (2019). Quality of life in patients with pituitary adenomas. Current Opinion in Endocrine and Metabolic Research, 7, 22–28. [Google Scholar] [Crossref]

25. https://doi.org/10.1016/j.coemr.2019.05.002 [Google Scholar] [Crossref]

26. Broersen, L. H. A., Zamanipoor Najafabadi, A. H., Pereira, A. M., Dekkers, O. M., van Furth, W. R., & Biermasz, N. R. (2021). Improvement in symptoms and health-related quality of life in acromegaly patients: A systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism, 106(2), 577–587. https://doi.org/10.1210/clinem/dgaa868 [Google Scholar] [Crossref]

27. Kimball, A., Dichtel, L. E., Yuen, K. C. J., et al. (2022). Quality of life after long-term biochemical control of acromegaly. Pituitary, 25(3), 531–539. https://doi.org/10.1007/s11102-022-01224-0 [Google Scholar] [Crossref]

28. van der Meulen, M., Zamanipoor Najafabadi, A. H., Lobatto, D. J., et al. (2021). Healthcare utilization and costs among prolactinoma patients: A cross-sectional study and analysis of determinants. Pituitary, 24(1), 79–95. https://doi.org/10.1007/s11102-020-01089-1 [Google Scholar] [Crossref]

29. Whittington, M. D., Munoz, K. A., Whalen, J. D., Ribeiro-Oliveira, A., & Campbell, J. (2021). Economic and clinical burden of comorbidities among patients with acromegaly. Growth Hormone & IGF Research, 59, 101389. https://doi.org/10.1016/j.ghir.2021.101389 [Google Scholar] [Crossref]

30. Melmed, S. (2020). Pituitary-tumor endocrinopathies. New England Journal of Medicine, 382(10), 937–950. https://doi.org/10.1056/NEJMra1810772 [Google Scholar] [Crossref]

31. Biermasz, N. R., Smit, J. W. A., & Pereira, A. M. (2017). Clinical characteristics and economic burden of acromegaly. Value in Health, 20(8), 1054–1061. https://doi.org/10.1016/j.jval.2017.05.016 [Google Scholar] [Crossref]

32. Fleseriu, M., et al. (2021). Consensus on diagnosis and management of Cushing’s disease: A guideline update. Lancet Diabetes & Endocrinology, 9(12), 847–875. https://doi.org/10.1016/S2213-858 7(21)00 235-7 [Google Scholar] [Crossref]

33. Petersenn, S., Fleseriu, M., Casanueva, F. F., et al. (2023). Diagnosis and management of prolactin-secreting pituitary adenomas: A Pituitary Society international consensus statement. Nature Reviews Endocrinology, 19(12), 722–740. https://doi.org/10.1038/s41574-023-00886-5 [Google Scholar] [Crossref]

34. Auriemma, R. S., Pirchio, R., Pivonello, C., et al. (2023). Approach to the patient with prolactinoma. Journal of Clinical Endocrinology and Metabolism, 108(9), 2400–2423. [Google Scholar] [Crossref]

35. https://doi.org/10.1210/clinem/dgad174 [Google Scholar] [Crossref]

• Measuring Waste of Patient Time in Health Care at Non-Digitized Hospital: An Observational Study in Bangabandhu Sheikh Mujib Medical University, Bangladesh
• Reaffirming Clinical Confidence in Atorvastatin Therapy: A Digital Outreach Case Study from Tamil Nadu, India
• Clinical Manifestations and Therapeutic Response in a Patient with Hypothyroidism: A Case Report
• Eranda (Ricinus Communis) In Gridhrasi (Sciatica): Classical Rationale, Pharmacology and Clinical Evidence- A Narrative Literature Review
• Magnetotherapy in Pain Management: Mechanisms, Clinical Applications, and Future Perspectives – A Review