The natural history and conservative management of patients with non-functioning pituitary adenoma

Amir H Sam, Sachit Shah, Keenan Saleh, Jay Joshi, Federico Roncaroli, Stephen Robinson, Jeremy Cox, Niamh M Martin, Nigel Mendoza, Karim Meeran, Amrish Mehta, Waljit S Dhillo



Context: The naturally history and the optimum management of patients with non-functioning pituitary adenomas (NFPAs) is unclear.


Objective: Our objective was to characterize the natural history of patients with pituitary non-functioning adenomas managed conservatively.


Design and Setting: We conducted a retrospective analysis of patient records at an endocrine centre in a tertiary referral hospital. The pituitary imaging for all patients was re-examined by two neuroradiologists in consensus.


Patients: We included patients with pituitary adenomas and no clinical or biochemical evidence of hormonal hypersecretion. Those presenting with apoplexy or a radiological follow-up period of less than 1 year were excluded.


Main outcome measures: The main outcome measures were change in tumour size and pituitary hormone function.


Results: Sixty-seven patients were managed conservatively for a mean follow-up period of 4.4 years (range: 1-14.7). Forty-eight (72%) were macroadenomas, fourteen (21%) were microadenomas 5-10 mm and five (7%) were microadenomas <5 mm. Overall, tumour size increased in 58%, reduced in 33% and remained stable in 9% of patients. Tumour size decreased or remained stable in 40% of macroadenomas, 50% of microadenomas 5-10mm, and 40% of microadenomas <5mm. The median annual growth rate of growing macroadenomas, microadenomas 5-10mm and microadenomas <5mm were 0.9 mm/year, 0.5 mm/year and 0.3 mm/year respectively. The median annual growth rate of macroadenomas was significantly higher than that of microadenomas 5-10mm (p<0.05) and that of all microadenomas (p<0.01). Sixty one percent of patients in the conservative group were deficient in at least one pituitary hormone. Sixty nine percent of patients with a macroadenoma had pituitary hormone deficiency in one or more axes, compared to 42% in microadenomas.


Conclusion: Patients with NFPAs without optic chiasm compression can be managed conservatively. All patients need pituitary function assessment, irrespective of tumour size.