Natural history of conservatively managed nonfunctioning pituitary macroadenomas in the elderly: A study from the Swedish Pituitary Registry
Authors' conclusion
Pituitary surgery was uncommon in conservatively managed elderly patients with macro-NFPAs. Baseline visual field defects, but not tumour size, were associated with subsequent surgery
Study context
- Population
- Patients ≥ 65 years in the Swedish Pituitary Registry diagnosed 1991–2023 with macro-NFPA and a decision for conservative management; 38% females38% females
- Participants
- 673 patients
- Exposure
- 65-72 vs 73-80 vs ≥ 81
- Outcome
- Adenoma progression, pituitary function, visual impairment and later surgery
- Follow-up
- 1- and 5-year ; surgery up to 7.5 years
Methodological detailsnational registry, conservatively managed
- National registry
- Conservatively managed
Main finding
As reported in the abstract
- Underwent surgery during follow-up
- 6.7%
- Later surgery associated with visual field defects at diagnosis (regression)
- p < 0.05
Observational data: associations, not effects.
Further findings
Hormone deficiencies by sex at diagnosis
P < 0.01
Baseline characteristics at diagnosis
- Mean age (years)
- 76
- Females older
- P < 0.001
- Mean adenoma diameter (mm)
- 20
- Mean adenoma volume (mm³)
- 3067
- Visual field defects
- 20%
- Reduced visual acuity
- 12%
- No sex differences in visual impairment
Age gradient at diagnosis
- Hormone deficiencies and visual impairments increased with age
- P < 0.001
- Oldest subgroup had the largest adenomas
- P < 0.01
- In oldest subgroup, females had larger tumours
- P < 0.05
- In oldest subgroup, males had more deficiencies
- P < 0.05
Original publication
Natural history of conservatively managed nonfunctioning pituitary macroadenomas in the elderly: A study from the Swedish Pituitary Registry. Pituitary. Published 20 August 2026. doi:10.
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