Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary Adenoma Consortium
Fountas, Athanasios Lithgow, Kirstie Loughrey, Paul Benjamin Bonanos, Efstathios Shinwari, Shah Khalid Mitchell, Kirsten Mavilakandy, Akash Ahsan, Masato Matheou, Mike Isand, Kristina
Fountas, Athanasios
Lithgow, Kirstie
Loughrey, Paul Benjamin
Bonanos, Efstathios
Shinwari, Shah Khalid
Mitchell, Kirsten
Mavilakandy, Akash
Ahsan, Masato
Matheou, Mike
Isand, Kristina
Affiliation
University of Birmingham; Birmingham Health Partners; University Hospitals Birmingham NHS Foundation Trust; Belfast Health and Social Care Trust; Queen's University Belfast; University Hospitals of North Midlands NHS Trust; NHS Greater Glasgow and Clyde; University Hospitals of Leicester NHS Trust; Oxford University Hospitals NHS Foundation Trust; University Hospitals Bristol and Weston NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Cardiff and Vale University Health Board; Newcastle-Upon-Tyne NHS Foundation Trust; Cambridge University Hospitals NHS Foundation Trust; University of Cambridge; Sheffield Teaching Hospitals NHS Foundation Trust; Norfolk and Norwich University Hospitals Foundation Trust; Barts Health NHS Trust; Liverpool University Hospitals NHS Foundation Trust; University College London Hospital NHS Foundation Trust; Christie NHS Foundation Trust; Manx Centre for Endocrinology, Diabetes and Metabolism; University of Manchester; NHS Grampian; Imperial College London; University of Sheffield; Royal Devon and Exeter NHS Foundation Trust
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Publication date
2025-04-30
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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.
Citation
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. Eur J Endocrinol. 2025 Apr 30;192(5):680-690. doi: 10.1093/ejendo/lvaf091.
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Article