Management of newly-diagnosed non-functioning pituitary adenomas (NFPAs) has evolved over the last decade. Whilst surgical debulking remains the mainstay of treatment for patients presenting with compressive disease, the use of pituitary irradiation has declined, with greater emphasis on observation or further surgical debulking. We aimed to compare outcomes of treatment for NFPAs at our institution since 2004 with older management strategies.
We reviewed records of 203 patients with NFPA referred for treatment to the Queen Elizabeth Hospital Birmingham between 1979 and 2012. Cases were subdivided into those presenting pre-2004 and post-2004. Treatment strategy at diagnosis was categorised as conservative, surgery or surgery plus radiotherapy (RTX). Tumour regrowth was diagnosed radiologically by a pituitary neuroradiologist. Pituitary function testing was performed preoperatively, 6 weeks postoperatively and annually thereafter.
203 patients were included (121 men) in the study. Mean age at diagnosis was 56.8±14.5 years. 57 patients were treated pre-2004 and 146 post-2004 (mean follow-up 14.6±6.5 and 6.7±2.4 years, respectively). The incidence of intrasellar tumour at diagnosis in each group was 1/57 and 10/146, respectively, P=0.002. Cavernous sinus invasion was higher at diagnosis in the pre-2004 group (23/57 vs 37/146, P=0.01). The rate of postoperative surgery plus RTX was higher in the pre-2004 group (29.8 vs 2.7%, P<0.0001), as was the rate of long-term panhypopituitarism (53.4 vs 31.2%, P=0.004). Intra- or extrasellar tumour remnant was found postoperatively in 90.1% pre-2004 and 71.5% post-2004 (P=0.03). The rate of tumour regrowth was 39.2 and 17.8% pre-2004 and post-2004 respectively, P=0.002.
Lower rates of postoperative pituitary irradiation since 2004 have led to a significant reduction in long-term hypopituitarism in our cohort. More aggressive surgical debulking resulting in reduced postoperative tumour burden may have lowered rates of tumour regrowth in recent years at minimum expense to pituitary function. Long-term follow-up is required to validate these findings.