Endocrine Abstracts

Transsphenoidal surgery is the first-line treatment for non-functioning pituitary macroadenomas (NFPAs) causing pressure symptoms. However, the approach to asymptomatic NFPAs is unclear due to the limited data on their natural progression. This study retrospectively analysed data from patients with NFPAs who underwent conservative management for at least six months. The study screened 175 individuals treated at the National Neurosurgery/Pituitary Centre at Beaumont Hospital between 2010 and 2020. Following screening, 90 patients met the inclusion criteria, encompassing a minimum of six months of conservative management, diagnosis of NFPA exceeding 1cm in size, and adequate follow-up. The mean age of the included patients was 56 years (range 15-85 years), 56% were male, and the median follow-up period was 44 months (interquartile range (IQR) 23-84 months). The median tumour volume was 2422 mm3(IQR 1121-4032 mm3). Meaningful progression was defined as an adenoma volume increase of 20% or more and/or visual field deterioration on formal examination. Two independent Neuro-radiologists blinded to patients’ symptoms confirmed true radiological progression. Forty patients (44%) demonstrated progression, with 21% representing visual field deterioration alone, 13% exhibiting radiological progression alone, and 10% presenting with both. The median time to radiological progression was 18.5 months (IQR 12-34 months). 19/90 (21%) underwent surgical resection, while the remaining 71 patients were managed conservatively and regularly monitored. Statistical analysis showed no association between tumour progression and age, gender, baseline tumour size, baseline pituitary status, baseline visual fields or extra pituitary extension. In conclusion, the findings show that approximately half of all conservatively managed NFPAs will progress at a median time of less than two years. The study did not identify any predictors of tumour enlargement, in keeping with prior published studies. This information is useful when counselling the patient regarding the merits of surgical vs conservative approaches to NFPAs.