Object: The natural history and proper algorithm for follow-up testing of nonfunctioning pituitary adenomas (NFPAs) are not well known, despite their relatively high prevalence. The aim of this study was to suggest the optimal follow-up algorithm for NFPAs, based on the natural history.
Methods: We followed up on 197 patients with NFPAs without any treatment (including surgery and radiation) at the time of detection, in a single center, between March 2000 and February 2017. We conducted a hormone test, visual field test and magnetic resonance imaging (MRI) at the time of diagnosis, and then, yearly.
Results: The overall median follow-up duration was 37 months. Microadenomas (n=38) did not cause visual disturbance, pituitary apoplexy, or endocrine dysfunction. The incidence of patents with a 120% or larger tumor volume growth was higher in macroadenomas than microadenomas (13.8% vs. 5.0% per year). The overall incidence rate of worsening visual function was 0.69% per year. Patients with a tumor volume growth rate ≥ 0.35 cm3/year (n=38) showed higher incidences of worsening visual functions (3.52% vs. 0.16% per year) and endocrine dysfunction (4.40% vs. 0.49% per year). Based on the tumor volume growth rate, the median time for 10% of patients to grow more than 120% was 3.4 years in microadenomas and 1.9 years in macroadenomas.
Conclusion: The tumor volume growth rate was the strongest predictor of worsening visual functions or endocrine dysfunction. A follow-up strategy needed to be determined based on the tumor volume growth rate as well as initial tumor volume.
19 - 22 May 2018
European Society of Endocrinology