Endocrine Abstracts

Introduction: Clinically non-functioning pituitary adenoma (NFPA) represents up to 30% of pituitary tumours. Management is dictated by their size or mass effect. The natural progression of NFPA attracts debate as the evidence-base is limited.

Methods: Conservatively managed NFPA patients were included. A single radiologist reviewed all images to avoid bias.

Results: Forty-six patients were identified, 21 female. Four presented acutely – two apoplexy, one headache and another visual disturbance; 26 were incidental diagnoses; 17 had hypogonadism, 14 requiring testosterone replacement. The mean tumour diameter was 19 mm (range 7-39 mm). 43 were macroadenoma. Majority were solid (38), the rest cystic or mixed. 28 had suprasellar extension. Of these, 13 were abutting, two were compressing and six were stretching the optic chiasm. 11 extended into the cavernous sinus. Three had haemorrhage in the lesion. The mean follow-up was 34 months. During this period, 13 shrank (−4.5 mm; range 1–24 mm). 17 remained unchanged. 16 showed enlargement (+2.5 mm; 1–11 mm). The longer the duration of follow-up, the larger was the increment. Eight had visual field defects, all had suprasellar tumour extension. Mean tumour size was 22 mm (7–39 mm). Among these, two increased in size by mean 7 mm over 52 months, but both had stable vision. The remaining had stable tumour. One had worsening vision, but tumour had shrunken by 5 mm. The decision to manage conservatively was either patient choice or the lack of progression of tumour/visual defect. One patient with worsening vision was unfit for surgery.

Conclusion: The natural progression of NFPA can be variable. In the absence of mass effect, these patients can be managed conservatively with radiological and orthoptic surveillance. Treatment decision should be made within a pituitary MDT setting involving the patient in decision-making. In those showing a tendency to grow, long term MRI surveillance is essential.