SFEBES2023 Oral Communications Neuroendocrinology and Pituitary (6 abstracts)
Long-term outcomes of non-operated non-functioning pituitary macroadenomas – results from the UK NFPA consortium
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 , Akash Mavilakandy 8 , Masato Ahsan 8 , Mike Matheou 9 , Kristina Isand 9 , Ross Hamblin 1,2,3,10 , David S. McLaren 11 , Hafiz Zubair Ullah 12 , Lydia Grixti 13 , James MacFarlane 14,15,16 , Anuradha Jayasuriya 17 , Sumbal Bhatti 18 , Wunna Wunna 19 , Syed Shah 20 , Ziad Hussein 21 , Susan Mathew 22 , Katarina Klaucane 23 , John Ayuk 2,3 , Joannis Vamvakopoulos 23 , Amutha Krishnan 23 , Claire Higham 22,24 , Prakash Abraham 25 , Stephanie E. Baldeweg 21 , Tejpal Purewal 20 , Janki Panicker 20 , Niamh Martin 26 , William M. Drake 19 , Rupa Ahluwalia 18 , John Newell-Price 17,27 , Mark Gurnell 14,15,16 , Yaasir Mamoojee 13 , Antonia Brooke 28 , Andrew Lansdown 12 , Robert D. Murray 11 , Karin Bradley 10 , Aparna Pal 9 , Narendra Reddy 8 , Miles J. Levy 8 , E. Marie Freel 7 , Biju Jose 6 , Steven J. Hunter 4 & Niki Karavitaki 1,2,3
1Institute of Metabolism and Systems Research, 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. 5Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom. 6Department of Endocrinology and Metabolic Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. 7Department of Endocrinology, Queen Elizabeth University Hospital, Glasgow, United Kingdom. 8Department of Endocrinology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 9Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. 10Department of Diabetes and Endocrinology, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom. 11Leeds Centre for Diabetes & Endocrinology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. 12Centre for Diabetes and Endocrinology, University Hospital of Wales, Cardiff, United Kingdom. 13Department of Endocrinology and Metabolic Medicine, The Newcastle-Upon-Tyne NHS Foundation Trust, Newcastle, United Kingdom. 14Department of Endocrinology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. 15Metabolic Research Laboratories, Wellcome MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom. 16NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom. 17Department of Endocrinology and Metabolism, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom. 18Department of Endocrinology, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, United Kingdom. 19Department of Endocrinology, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom. 20Department of Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom. 21Department of Diabetes & Endocrinology, University College London Hospital NHS Foundation Trust, London, United Kingdom. 22Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, United Kingdom. 23Manx Centre for Endocrinology, Diabetes & Metabolism, Manx Care, Douglas, Isle of Man, United Kingdom. 24University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. 25Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom. 26Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom. 27Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom. 28Department of Endocrinology and Metabolism, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
Background: Large series of patients elucidating the natural history of conservatively managed non-functioning pituitary macroadenomas (macroNFPAs) and relevant prognostic factors are not available.
Objectives: Clarify long-term outcomes of macroNFPAs in large cohort of patients.
Methods: Multi-centre [21 UK endocrine departments-UK NFPA consortium], retrospective, cohort study of cases of (presumed) macroNFPAs offered surveillance as initial management (patients presenting with apoplexy or without follow-up excluded). Clinical/imaging/visual data were collected. Statistical analyses: Kaplan-Meier survival curves, Cox-regression.
Results: 949 patients were included [549 (57.9%) men]. Median age and diameter at tumour detection were 63 years (IQR 49-75) and 17 mm (IQR 13-21), respectively. Imaging features at presentation: 15.1% only intrasellar, 55.4% suprasellar extension, 25.3% cavernous sinus extension, 24.7% >1 extensions. During median period of 3.6 years (IQR 1.3-6.6), 385 (40.6%) macroNFPAs grew, 83 (8.7%) reduced in size and 481 (50.7%) remained stable. Cumulative probabilities: growth 1.6%, 8.1%, 29.2%, 43.6% at 6 months, 1, 3, 5 years, respectively; shrinkage 7.1%, 9.6% at 3, 5 years, respectively. Fifteen (1.6%) patients developed clinical apoplexy. On multivariate regression analysis, male sex [HR 1.334;95%CI 1.052-1.693; P=0.018] and age [HR 1.010;95%CI 1.003-1.018; P=0.008] were predictors of growth, whereas presence of supra-/ extrasellar extensions showed trend towards significance [HR 1.431;95%CI 0.996-2.055; P=0.052] (3-year probability of growth: 18% if only intrasellar, 31.2% if with extensions). Amongst 458 patients with tumours not abutting/compressing optic chiasm at presentation, 9 (2%) developed visual field defects due to first episode of enlargement and surgery led to improvement/normalisation in 8 of them.
Conclusions: In this largest to-date series of non-operated macroNFPAs, we have shown 43.6% 5-year probability of growth. Development of apoplexy is very rare. Enlargement 6 months after detection is extremely unlikely, suggesting that first surveillance imaging could be performed at one year (with visual assessment in the interim for tumours abutting/compressing optic pathways).
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