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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.

Additional file 1.

The current study was being performed to evaluate the birth complications in diabetic mothers; including both maternal and fetal complications; miscarriages. The nature of study was observational cross-sectional study. The study was being taken place at different hospitals, clinical settings, and maternity homes of Lahore during September 2016 - November 2016. The demographic data, family history, socio-economic history, indications, examination findings, results, lab findings etc. were recorded. Total 200 pregnant diabetic patients were evaluated for this study. The age limit for this study was 18-40 years. The patients were being analyzed for their FBS/ BSR or Hb findings and the type of diabetes was being recorded. Out of 200 patients, 81% had GDM while the remaining patients were being presented with pregestational diabetes (type I 5%, type II 14% patients). Most of the GDM cases were being diagnosed during 5th to 8th week of pregnancy. Out of 200 pregnancies, 20.5% (41) of these patients had normal pregnancies, and had no major fetal complications except uncontrolled sugar level in mothers. Remaining 79.5% (159) pregnancies/deliveries were associated with some major complications including respiratory distress, macrosomia, hypoglycemic babies, CVS malformations and still births/miscarriages. The ratio of normal vaginal delivery to CS was found out to be 29% to & 76%. The major indications for these CS deliveries were placental abruption (19.74%), dystocia (14.47%), uterine rupture (13.16%), breech position (6.58%), fetal distress (46.05%) and to some extent previous CS. The miscarriages were being associated with hypertension (41.5%), polyhydramnios (22%), Hughes syndrome (12.2%), and uncontrolled sugar level (24.3%). In our study population TT immunization status was good i.e. 76%. Diabetes is still a major problem of birth complications and miscarriages. Public awareness program is required to educate the people about reproductive health and to motivate them to undergo BSR/FBS during pregnancy prior to 24thgestational weeks to diagnose for GDM.