Endocrine Abstracts

Background: Clinically non-functioning pituitary adenomas (NFPA) are the most common pituitary adenomas but their treatment remains challenging. Our aim is to describe clinical, imagiological and hormonal characteristics of patients with NFPA presenting at our department.

Methods: Retrospective review of medical records of patients with NFPA at our centre from 1996 to 2016. Exclusion criteria: prolactin >100 ng/ml or histologic evidence of prolactinoma. Statistical analysis: SPSSv20.

Results: 179 patients included, 52% (n=92) female, with a median age of 61 years (IQR 48–73) and follow-up time of 5 years (IQR 3–10). The diagnosis were more frequent in the last 10 years (n=114, 64%). 40% (n=62) had hypertension and 15% (n=24) were diabetic. The initial presentation was neuro-ophthalmologic symptoms (n=87, 52%), incidentally discovered adenomas (n=36, 21%), pituitary apoplexy (n=30, 18%) and endocrine disorders (n=16, 9%). Pituitary function assessment showed that half (n=69) had at least one hormonal deficiency, specifically; LH/FSH deficiency was detected in 45%, ACTH in 25%, TSH in 30% and GH in 15%. Hyperprolactinemia was present in 22% (n=30). Five patients (3%) had diabetes insipidus. The NFPA were mainly macroadenomas (n=146, 89.5%) with suprasellar extension (n=89, 70%), 36% (n=43) had sphenoidal and 30.3% (n=36) cavernous sinus invasion. Surgery was performed in 54% patients (n=96), while the remaining maintained expectant observation. Immunohistochemical analyses showed 42 null-cell, 34 gonadotrophs, 1 silent thyrotroph, 2 silent corticotroph and 2 plurihormonal adenomas.

Discussion: As in other series, our patients also presented with visual disturbances and pituitary dysfunction at diagnosis, but we found and older population. We emphasize that a quarter of patients had ACTH and 30% TSH deficiency that can cause a significant morbidity and had not been suspected before. Hence, earlier diagnosis of hypopituitarism and prompt treatment are imperative.