Endocrine Abstracts (2017) 49 EP1071 | DOI: 10.1530/endoabs.49.EP1071

Surgery versus expectant observation in clinically non-functioning pituitary adenomas - a 20-year single centre experience

Claudia Matta-Coelho1, Rui Almeida2 & Olinda Marques1

1Endocrinology Department, Braga Hospital, Braga, Portugal; 2Neurosurgery Department, Braga Hospital, Braga, Portugal.

Background: Clinically non-functioning pituitary adenomas (NFPAs) are among the most common pituitary lesions. Its management includes surgery, radiation or observation. The authors aim to compare clinical characteristics and outcomes between patients submitted to surgery or expectant observation (EO).

Methods: Retrospective review of medical records from 1996 to 2016. In our centre, there is only 1 pituitary surgeon and NFPAs patients are referred to surgery according to the presence of neurologic symptoms, mainly visual disturbances, and tumour growth. Statistical analysis: SPSSvs20.

Results: We found 179 patients, 52% (92 females), with a median follow-up time of 5 years (IQR 3–10), 54% (n=96) underwent surgery. Besides indication for surgery, 2 patients refused and 3 did not have clinical conditions. Patients that underwent surgery were younger (58 vs 68 years, P<0,001), had more neurologic symptoms at diagnosis (62 vs 39%, P=0.011) and visual disturbances (64 vs 22%, P<0.001) than patients in EO. There were no differences in hormonal deficiencies (P<0.001). The surgery group presented larger adenomas (26 vs 15 mm, P<0.001) and further suprasellar extension (P=0.015), cavernous (P=0.008) and sphenoidal sinus invasion (P=0.006). Surgery occurred after a median of 12 months (IQR 0–12), since imagiologic diagnosis and 26% (n=25) required a second intervention. 13% (n=12) were submitted to radiotherapy. After surgery, 11 patients (16%) had hormonal deficiencies, while 8 (12%) improved. In the EO group, we found de novo hypogonadism in 3 patients and hypothyroidism in 1. No significant tumour growth was observed and none suffered apoplexia.

Discussion: Patients that underwent surgery were in average 10 years younger, had more neuro-ophthalmologic symptoms and bigger tumours at presentation. Those in vigilant observation did not present significant tumour growth, new hormonal deficiencies or apoplexy. Facing literature data, our population underwent fewer surgeries. EO may be a valuable option in selected NFPAs.

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