Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium
Authors' conclusion
Probability of micro-NFPA growth is low, and the development of new hypopituitarism is rare. Delaying the first follow-up MRI to 3 years and avoiding hormonal re-evaluation in the absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance.
Study context
- Population
- Patients with non-functioning pituitary microadenomas (micro-NFPAs), January 1, 2008 to December 21, 2021; median age at detection 44 years (IQR 31–57), 152 males/307 females419 with >2 magnetic resonance imagings (MRIs)
- Participants
- 459 patients
- Outcome
- Natural history of micro-NFPAs: cumulative probability of growth
Methodological detailsmulticentre, 23 endocrine departments (UK NFPA consortium)
- Multicentre
- 23 endocrine departments (UK NFPA consortium)
Main finding
As reported in the abstract
Cumulative probability of micro-NFPA growth · 3 and 5 years
- Growth at 3 years
- 7.8% (95% CI, 4.9%-8.1%)
- Growth at 5 years
- 14.5% (95% CI, 10.2%-18.8%)
- Reduction at 3 years
- 14.1% (95% CI, 10.4%-17.8%)
- Reduction at 5 years
- 21.3% (95% CI, 16.4%-26.2%)
- Median tumour enlargement
- 2 mm (IQR 1-3)
- Micro-NFPAs that grew becoming macroadenomas (nearly all >5 mm at detection)
- 49%
Observational data: associations, not effects.
Further findings
Predictors of enlargement/reduction
- Sex, age and size at baseline were not predictors of enlargement/reduction
Hypopituitarism at detection
- Secondary hypogonadism
- 7.2%
- Hypothyroidism
- 1.7%
- Hypoadrenalism
- 1.5%
Surgery
- Patients receiving surgery
- 8 (1.9%)
- Only one had visual compromise, with surgery required >3 years after detection
Safety
- Apoplexy
- 1 case
- New hypopituitarism during follow-up (after progression to macroadenoma)
- 2 (0.6%)
Original publication
Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium. Eur J Endocrinol. Published 22 June 2023. doi:10.
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