Endocrinology

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https://wwl.dspace-express.com/handle/20.500.13063/34
Collection of research outputs from the Endocrinology department

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    Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium
    (Oxford Academic, 2023-07) Hamblin, R; Fountas, A; Lithgow, K; Loughrey, PB; Bonanos, E; Shinwari, SK; Mitchell, K; Shah, S; Grixti, L; Matheou, M; Isand, K; McLaren, DS; Surya, A; Ullah, HZ; Klaucane, K; Jayasuriya, A; Bhatti, S; Mavilakandy, A; Ashan, M; Mathew, S; Hussein, Z; Jansz, T; Wunna, W; MacFarlane, J; Ayuk, J; Abraham, P; Drake, WM; Gurnell, M; Brooke, A; Baldeweg, SE; Sam, AH; Martin, N; Higham, C; Reddy, N; Levy, MJ; Ahluwalia, R; Newell-Price, J; Vamvakopoulos, J; Krishnan, A; Lansdown, A; Murray, RD; Pal, A; Bradley, K; Mamoojee, Y; Purewal, T; Panicker, J; Freel, EM; Hasan, F; Kumar, M; Jose, B; Hunter, SJ; Karavitaki, N
    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 January, 1, 2008 and December, 21, 2021 were analysed. Results: Data for 459 patients were retrieved [median age at detection 44 years (IQR 31-57)-152 males/307 females]. Four hundred and nineteen patients had more than two magnetic resonance imagings (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, and size at baseline were not predictors of enlargement/reduction. At the 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 the development of new hypopituitarism is rare. Delaying the first follow-up MRI to 3 years and avoiding hormonal re-evaluation in the absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance.