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Natural history of non-functioning pituitary microadenomas - results from the UK NFPA consortium

Authors :
Hamblin, Ross
Fountas, Athanasios
Lithgow, Kirstie
Loughrey, Paul Benjamin
Bonanos, Efstathios
Shinwari, Shah Khalid
Mitchell, Kirsten
Shah, Syed
Grixti, Lydia
Matheou, Mike
Isand, Kristina
McLaren, David S
Surya, Ashutosh
Ullah, Hafiz Zubair
Klaucane, Katarina
Jayasuriya, Anuradha
Bhatti, Sumbal
Mavilakandy, Akash
Ahsan, Masato
Mathew, Susan
Hussein, Ziad
Jansz, Thijs
Wunna, Wunna
MacFarlane, James
Ayuk, John
Abraham, Prakash
Drake, William M
Gurnell, Mark
Brooke, Antonia
Baldeweg, Stephanie E
Sam, Amir H
Martin, Niamh
Higham, Claire
Reddy, Narendra
Levy, Miles J
Ahluwalia, Rupa
Newell-Price, John
Vamvakopoulos, Joannis
Krishnan, Amutha
Lansdown, Andrew
Murray, Robert D
Pal, Aparna
Bradley, Karin
Mamoojee, Yaasir
Purewal, Tejpal
Panicker, Janki
Freel, E Marie
Hasan, Faisal
Kumar, Mohit
Jose, Biju
Hunter, Steven J
Karavitaki, Niki
Gurnell, Mark [0000-0001-5745-6832]
Murray, Robert D [0000-0001-6730-6109]
Karavitaki, Niki [0000-0002-4696-0643]
Apollo - University of Cambridge Repository
Publication Year :
2023
Publisher :
Oxford University Press (OUP), 2023.

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.

Details

Database :
OpenAIRE
Accession number :
edsair.doi.dedup.....70b6a3ea61529c37da2e43208a2ecb40