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Lookup NU author(s): Dr Lydia Grixti, Dr Yaasir Mamoojee
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s). Published by Oxford University Press on behalf of European Society of Endocrinology.Objective: Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium. Design: This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments. Methods: Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed. Results: Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%). Conclusions: Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment.
Author(s): Fountas A, Lithgow K, Loughrey PB, Bonanos E, Shinwari SK, Mitchell K, Mavilakandy A, Ahsan M, Matheou M, Isand K, Hamblin R, McLaren DS, Ullah HZ, Grixti L, Macfarlane J, Jayasuriya A, Bhatti S, Wunna W, Shah S, Hussein Z, Mathew S, Klaucane K, Ayuk J, Toogood A, Tsermoulas G, Ahmed S, Paluzzi A, Batra R, Vamvakopoulos J, Krishnan A, Higham C, Abraham P, Baldeweg SE, Purewal T, Panicker J, Martin N, Drake WM, Ahluwalia R, Newell-Price J, Gurnell M, Mamoojee Y, Brooke A, Lansdown A, Murray RD, Bradley K, Pal A, Reddy N, Levy MJ, Freel EM, Jose B, Hunter SJ, Karavitaki N
Publication type: Article
Publication status: Published
Journal: European Journal of Endocrinology
Year: 2025
Volume: 192
Issue: 5
Pages: 680-690
Online publication date: 30/04/2025
Acceptance date: 28/04/2025
Date deposited: 16/06/2025
ISSN (print): 0804-4643
ISSN (electronic): 1479-683X
Publisher: Oxford University Press
URL: https://doi.org/10.1093/ejendo/lvaf091
DOI: 10.1093/ejendo/lvaf091
PubMed id: 40305776
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