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. 2023 Jul 20;189(1):87-95.
doi: 10.1093/ejendo/lvad070.

Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium

Ross Hamblin  1   2   3 , Athanasios Fountas  1   2   3 , Kirstie Lithgow  1   2   3 , Paul Benjamin Loughrey  4   5 , Efstathios Bonanos  4 , Shah Khalid Shinwari  6 , Kirsten Mitchell  7 , Syed Shah  8 , Lydia Grixti  9 , Mike Matheou  10 , Kristina Isand  10 , David S McLaren  11 , Ashutosh Surya  12 , Hafiz Zubair Ullah  12 , Katarina Klaucane  13 , Anuradha Jayasuriya  14 , Sumbal Bhatti  15 , Akash Mavilakandy  16 , Masato Ahsan  16 , Susan Mathew  17 , Ziad Hussein  18 , Thijs Jansz  19 , Wunna Wunna  20 , James MacFarlane  21   22   23 , John Ayuk  2   3 , Prakash Abraham  24 , William M Drake  20 , Mark Gurnell  21   22   23 , Antonia Brooke  19 , Stephanie E Baldeweg  18 , Amir H Sam  25 , Niamh Martin  25 , Claire Higham  17   26 , Narendra Reddy  16 , Miles J Levy  16 , Rupa Ahluwalia  15 , John Newell-Price  14   27 , Joannis Vamvakopoulos  13 , Amutha Krishnan  13 , Andrew Lansdown  12 , Robert D Murray  11 , Aparna Pal  10 , Karin Bradley  28 , Yaasir Mamoojee  9 , Tejpal Purewal  8 , Janki Panicker  8 , E Marie Freel  7 , Faisal Hasan  29 , Mohit Kumar  30 , Biju Jose  6 , Steven J Hunter  4 , Niki Karavitaki  1   2   3
Affiliations
Free article

Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium

Ross Hamblin et al. Eur J Endocrinol. .
Free article

Abstract

Objective: The optimal approach to the surveillance of non-functioning pituitary microadenomas (micro-NFPAs) is not clearly established. Our aim was to generate evidence on the natural history of micro-NFPAs to support patient care.

Design: Multi-centre, retrospective, cohort study involving 23 endocrine departments (UK NFPA consortium).

Methods: Clinical, imaging, and hormonal data of micro-NFPA cases between January, 1, 2008 and December, 21, 2021 were analysed.

Results: Data for 459 patients were retrieved [median age at detection 44 years (IQR 31-57)-152 males/307 females]. Four hundred and nineteen patients had more than two magnetic resonance imagings (MRIs) [median imaging monitoring 3.5 years (IQR 1.71-6.1)]. One case developed apoplexy. Cumulative probability of micro-NFPA growth was 7.8% (95% CI, 4.9%-8.1%) and 14.5% (95% CI, 10.2%-18.8%) at 3 and 5 years, respectively, and of reduction 14.1% (95% CI, 10.4%-17.8%) and 21.3% (95% CI, 16.4%-26.2%) at 3 and 5 years, respectively. Median tumour enlargement was 2 mm (IQR 1-3) and 49% of micro-NFPAs that grew became macroadenomas (nearly all >5 mm at detection). Eight (1.9%) patients received surgery (only one had visual compromise with surgery required >3 years after micro-NFPA detection). Sex, age, and size at baseline were not predictors of enlargement/reduction. At the time of detection, 7.2%, 1.7%, and 1.5% patients had secondary hypogonadism, hypothyroidism, and hypoadrenalism, respectively. Two (0.6%) developed hypopituitarism during follow-up (after progression to macroadenoma).

Conclusions: 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.

Keywords: adenoma; incidentaloma; natural history; non-functioning; pituitary.

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Conflict of interest statement

Conflicts of interest: None declared.