Conservatively managed non-functioning pituitary macroadenomas—cohort study from the UK Non-functioning Pituitary Adenoma Consortium
Authors' conclusion
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.
Study context
- Population
- Patients with non-functioning pituitary macroadenomas (macroNFPAs) managed initially with monitoring, 21 UK endocrine departments, UK NFPA Consortium, followed 2005–2022
- Participants
- 949 patients
- Outcome
- Tumour enlargement
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
- Incidence rate of tumour enlargement
- 9.8 per 100 patient-years (95% CI 8.8-10.8)
- Cumulative probability of enlargement at 6 months
- 1.6%
- Cumulative probability of enlargement at 1 year
- 8.1%
- Cumulative probability of enlargement at 2 years
- 18.4%
- Cumulative probability of enlargement at 3 years
- 29.2%
- Cumulative probability of enlargement at 5 years
- 43.6%
Observational data: associations, not effects.
Further findings
Visual fields in tumours not in contact with optic chiasm enlarging within 6 months
- Visual fields impacted
- 0
Tumour behaviour after enlargement with continued monitoring · median 2.6 years
- Further growth
- 60.5%
- Probability of further growth at 2 years
- 33.8%
- Stability
- 35.5%
- Shrinkage
- 4.0%
New pituitary hormone deficits
- Rates of new pituitary hormone deficits, mainly driven by tumour enlargement
- 4.0%-4.9%
Hypopituitarism reversal after transsphenoidal surgery
- Hypopituitarism reversal
- 12%-17%
Safety
Hormone deficits after transsphenoidal surgery
- Additional anterior pituitary hormone deficits
- 12%-15%
- Permanent vasopressin deficiency
- 3.5%
Original publication
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