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Natural history of non-functioning pituitary microadenomas - results from the UK NFPA consortium
Hamblin, R. Fountas, A. Lithgow, K. Loughrey, P. B. Bonanos, E. Shinwari, S. K. Mitchell, K. Shah, S. Grixti, L. Matheou, M.
Hamblin, R.
Fountas, A.
Lithgow, K.
Loughrey, P. B.
Bonanos, E.
Shinwari, S. K.
Mitchell, K.
Shah, S.
Grixti, L.
Matheou, M.
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Abstract
Objective: The optimal approach to the surveillance of non-functioning pituitary microadenomas (micro-NFPAs) is not clearly established. Our aim was to generate evidence on the natural history of micro-NFPAs to support patient care.
Design: Multi-centre, retrospective, cohort study involving 23 endocrine departments (UK NFPA consortium).
Methods: Clinical, imaging, and hormonal data of micro-NFPA cases between 1/1/2008 and 21/12/2021 were analysed.
Results: Data for 459 patients were retrieved [median age at detection 44 years [interquartile range (IQR) 31-57) - 152 males/307 females]. 419 patients had more than two MRIs [median imaging monitoring 3.5 years (IQR 1.71-6.1)]. One case developed apoplexy. Cumulative probability of micro-NFPA growth was 7.8% (95%CI 4.9%-8.1%) and 14.5% (95%CI 10.2%-18.8%) at 3 and 5 years, respectively, and of reduction 14.1% (95%CI 10.4-17.8%) and 21.3% (95%CI 16.4-26.2%) at 3 and 5 years, respectively. Median tumour enlargement was 2 mm (IQR 1-3) and 49% of micro-NFPAs that grew became macroadenomas (nearly all >5 mm at detection). Eight (1.9%) patients received surgery (only one had visual compromise with surgery required >3 years after micro-NFPA detection). Sex, age, size at baseline were not predictors of enlargement/reduction. At time of detection, 7.2%, 1.7% and 1.5% patients had secondary hypogonadism, hypothyroidism and hypoadrenalism, respectively. Two (0.6%) developed hypopituitarism during follow-up (after progression to macroadenoma).
Conclusions: Probability of micro-NFPA growth is low and development of new hypopituitarism is rare. Delaying first follow-up MRI to three years and avoiding hormonal re-evaluation in absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance.
Authors
Hamblin, R.
Fountas, A.
Lithgow, K.
Loughrey, P. B.
Bonanos, E.
Shinwari, S. K.
Mitchell, K.
Shah, S.
Grixti, L.
Matheou, M.
Isand, K.
McLaren, D. S.
Surya, A.
Ullah, H. Z.
Klaucane, K.
Jayasuriya, A.
Bhatti, S.
Mavilakandy, A.
Ahsan, M.
Mathew, Susan
Hussein, Z.
Jansz, T.
Wunna, W.
MacFarlane, J.
Ayuk, J.
Abraham, P.
Drake, W. M.
Gurnell, M.
Brooke, A.
Baldeweg, S. E.
Sam, A. H.
Martin, N.
Higham, Claire E
Reddy, N.
Levy, M. J.
Ahluwalia, R.
Newell-Price, J.
Vamvakopoulos, J.
Krishnan, A.
Lansdown, A.
Murray, R. D.
Pal, A.
Bradley, K.
Mamoojee, Y.
Purewal, T.
Panicker, J.
Freel, E. M.
Hasan, F.
Kumar, M.
Jose, B.
Hunter, S. J.
Karavitaki, N.
Fountas, A.
Lithgow, K.
Loughrey, P. B.
Bonanos, E.
Shinwari, S. K.
Mitchell, K.
Shah, S.
Grixti, L.
Matheou, M.
Isand, K.
McLaren, D. S.
Surya, A.
Ullah, H. Z.
Klaucane, K.
Jayasuriya, A.
Bhatti, S.
Mavilakandy, A.
Ahsan, M.
Mathew, Susan
Hussein, Z.
Jansz, T.
Wunna, W.
MacFarlane, J.
Ayuk, J.
Abraham, P.
Drake, W. M.
Gurnell, M.
Brooke, A.
Baldeweg, S. E.
Sam, A. H.
Martin, N.
Higham, Claire E
Reddy, N.
Levy, M. J.
Ahluwalia, R.
Newell-Price, J.
Vamvakopoulos, J.
Krishnan, A.
Lansdown, A.
Murray, R. D.
Pal, A.
Bradley, K.
Mamoojee, Y.
Purewal, T.
Panicker, J.
Freel, E. M.
Hasan, F.
Kumar, M.
Jose, B.
Hunter, S. J.
Karavitaki, N.
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Date
2023
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Article
Citation
Hamblin R, Fountas A, Lithgow K, Loughrey PB, Bonanos E, Shinwari SK, et al. Natural history of non-functioning pituitary microadenomas - results from the UK NFPA consortium. Eur J Endocrinol. 2023 Jun 22. PubMed PMID: 37345849. Epub 2023/06/22. eng.