SFEBES2022 Poster Presentations Neuroendocrinology and Pituitary (72 abstracts)
Natural history of non-functioning pituitary microadenomas – results from the UK NFA consortium
Ross Hamblin 1,2,3 , Athanasios Fountas 1,2,3 , Kirstie Lithgow 1,2,3 , Paul Benjamin Loughrey 4 , Efstathios Bonanos 4 , Shah Khalid Shinwari 5 , Kirsten Mitchell 6 , Syed Shah 7 , Lydia Grixti 8 , Mike Matheou 9 , Kristina Isand 9 , David McLaren 10 , Ashutosh Surya 11 , Hafiz Zubair Ullah 11 , Katarina Klaucane 12 , Anuradha Jayasuriya 13 , Sumbal Bhatti 14 , Akash Mavilakandy 15 , Masato Ahsan 15 , Susan Mathew 16 , Ziad Hussein 17 , Thijs Jansz 18 , Wunna Wunna 19 , John Ayuk 2,4 , Prakash Abraham 20 , William Drake 19 , Antonia Brooke 18 , Stephanie E. Baldeweg 17 , Amir H. Sam 21 , Niamh Martin 21 , Claire Higham 16 , Narendra Reddy 15 , Rupa Ahluwalia 14 , John Newell-Price 13,4 , Joannis Vamvakopoulos 12 , Amutha Krishnan 23 , Andrew Lansdown 11 , Robert D Murray 10 , Aparna Pal 9 , Karin Bradley 24 , Yaasir Mamoojee 8 , Tejpal Purewal 7 , Janki Panicker 7 , E Marie Freel 6 , Faisal Hasan 25 , Mohit Kumar 26 , Biju Jose 5 , Steven Hunter 4 & Niki Karavitaki 1,2,3
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom; 3Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 4Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, United Kingdom; 5Department of Endocrinology and Metabolic medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom; 6Department of Endocrinology, Queen Elizabeth University Hospital, Glasgow, United Kingdom; 7Department of Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; 8Department of Endocrinology and Metabolic Medicine, The Newcastle-Upon-Tyne NHS Foundation Trust, Newcastle, United Kingdom; 9Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; 10Department of Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, United Kingdom; 11Centre for Diabetes and Endocrinology, University Hospital of Wales, Cardiff, United Kingdom; 12Manx Centre for Endocrinology, Diabetes & Metabolism, Noble’s Hospital, Douglas, Isle of Man; 13Department of Endocrinology and Metabolism, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; 14Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, United Kingdom; 15Department of Diabetes and Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 16Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, United Kingdom; 17Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, United Kingdom; 18Department of Endocrinology and Metabolism, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom; 19Department of Endocrinology, St Bartholomew’s Hospital, Barts Health NHS trust, London, United Kingdom; 20Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; 21Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom; 22Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, United Kingdom; 23Manx Centre for Endocrinology, Diabetes & Metabolism, Noble’s Hospital, Douglas, United Kingdom; 24Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom; 25Department of Diabetes and Endocrinology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom; 26Department of Endocrinology and Metabolic Medicine, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
Background: The published data on the natural history of (presumed) non-functioning pituitary microadenomas (micro-NFAs) is possibly compromised by small sample sizes, short follow-up and inclusion of cases with other pathologies in the analyses.
Objective: To clarify the long-term outcomes of micro-NFAs in a large cohort of patients.
Methods: We conducted a multi-centre, retrospective, cohort study involving 22 UK endocrine departments (UK NFA consortium). Cases of (presumed) micro-NFAs detected by MRI and seen in participating departments were included. Clinical, imaging and hormonal data were collected. Statistical analyses were performed by Kaplan-Meier survival curves and Cox-regression.
Results: 453 patients were included. Median age at tumour detection was 44 years (IQR 31-57). At baseline, 35 (7.1%), 8 (1.8%) and 7 (1.5%) patients had secondary hypogonadism, hypothyroidism and hypoadrenalism (not attributable to other causes), respectively. For 413 patients with ≥ 2 follow-up MRIs, median monitoring was 3.5 years (IQR 1.7 – 6.1). 49 (11.9%) micro-NFAs grew, 79 (19.1%) reduced in size and 285 (69%) remained stable. Cumulative probability of growth was 7.6% (95%CI 4.7 – 10.5%), 14.3% (95%CI 10.0 – 18.6%) and 18.1% (95%CI 12.8% – 23.4%) at 3, 5 and 7 years, respectively; age at diagnosis, sex, tumour size (<5 mm or ≥ 5 mm) were not predictive factors. Two patients developed clinical apoplexy. Twenty-five (6.1%) micro-NFAs became macroadenomas (24/25 were > 5 mm at diagnosis), 7 (28%) of which had surgery. Two patients (0.5%) (who also had tumour growth) developed new hypopituitarism.
Conclusions: In this UK NFA consortium study, we have shown that the 5-year probability of micro-NFA growth is low (14%), and development of new hypopituitarism is exceptionally rare. Progression to macroadenoma is an unusual event. Need for surgical intervention during follow-up is very uncommon. Following detection, surveillance imaging for micro-NFAs <5 mm can be delayed by at least 3 years and additional hormonal testing is necessary only if tumour growth.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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