Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary Adenoma Consortium.

Fountas, A.; Lithgow, K.; Loughrey, PB.; Bonanos, E.; Shinwari, SK.; Mitchell, K.; Mavilakandy, A.; Ahsan, M.; Matheou, M.; Isand, K.; Hamblin, R.; McLaren, DS.; Ullah, HZ.; Grixti, L.; MacFarlane, J.; Jayasuriya, A.; Bhatti, S.; Wunna, W.; Shah, S.; Hussein, Z.; Mathew, S.; Klaucane, K.; Ayuk, J.; Toogood, A.; Tsermoulas, G.; Ahmed, S.; Paluzzi, A.; Batra, R.; Vamvakopoulos, J.; Krishnan, A.; Higham, C.; Abraham, P.; Baldeweg, SE.; Purewal, T.; Panicker, J.; Martin, N.; Drake, WM.; Ahluwalia, R.; Newell-Price, J.; Gurnell, M.; Mamoojee, Y.; Brooke, A.; Lansdown, A.; Murray, RD.; Bradley, K.; Pal, A.; Reddy, N.; Levy, MJ.; Freel, EM.; Jose, B.; Hunter, SJ.; Karavitaki, N.

Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary Adenoma Consortium.

All Authors

Fountas, A.

Lithgow, K.

Loughrey, PB.

Bonanos, E.

Shinwari, SK.

Mitchell, K.

Mavilakandy, A.

Ahsan, M.

Matheou, M.

Isand, K.

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LTHT Author

McLaren, David
Murray, Robert

LTHT Department

Doctors' Rotation
Specialty & Integrated Medicine
Diabetes & Endocrinology

Publication Date

2025

Item Type

Journal Article
Multicenter Study

Abstract

OBJECTIVE: Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium. DESIGN: This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments. METHODS: Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed. RESULTS: Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%). CONCLUSIONS: Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment.