Endocrine Abstracts

Background and Aim: Non-functioning pituitary adenomas (NFPAs) are hormonally inactive adenohypophyseal tumors. The absence of hormone hypersecretion and the lack of clinical manifestations delay the diagnosis and therefore symptoms of mass effect are frequently seen in NFPAs. The primary endpoint of this study was to evaluate the clinical presentation of patients with NFPAs and their therapeutic management. The secondary endpoint was to identify how gender and tumor size impact the clinical presentation and therapeutic management.

Patients and Methods: We evaluated 98 patients diagnosed with clinically and biochemically NFPAs between January 2013 and January 2018. Anamnestic data, symptoms at presentation, pituitary function and imaging, treatment option and outcomes were analysed.

Results: 68 of the patients were female (69.39%) and 30 male (30.61%), with a mean age of 43.61 ± 18.42 years. The most common symptom at presentation was headache (30.61%), followed by diplopia (13.27%) and bitemporal hemianopsia (13.27%), ptosis (9.18%), quadranopsia (1.02%). The prevalence of endocrine disorders caused by pituitary stalk compression was 22.9% for hyperprolactinemia and 6.9% for diabetes insipidus. GH deficiency was the most prevalent pituitary hormone deficiency (41.3%), followed by TSH deficiency (22.81%) and gonadotropin deficiency (15.31%). More than half of NFPAs were diagnosed as microadenomas (50.67%). The most used approach was conservative management (69.39%), followed by surgery (22.45%), radiation therapy (4.08%), surgery and radiation therapy (4.08%). Tumoral recurrence was seen in 6% of patients who underwent surgery, radiation therapy or both. The age at diagnosis was significantly higher in men, compared to women (49.41 ± 20.8 vs 41.1 ± 16.85 years, P = 0.042). Moreover, macroadenomas were more common in males than in females (85.71% vs 35.19%, P < 0.001). When dividing the patients based on tumor size we found a higher age at diagnosis for macroadenomas, compared to microadenomas (51.97 ± 17.07 vs 34.38 ± 15.19 years, P < 0.001), but also different treatment strategies: in microadenomas conservative management was chosen in 97.37% and surgery in 2.63% of patients, while in macroadenomas surgery was preffered in 40.54% and conservative management in 45.95% of patients (P <0.001).

Conclusions: NFPAs are characterized by heterogeneity in clinical presentation, patients usually presenting with symptoms of mass effect or hipopituitarism. In this regard our data showed a high prevalence of GH deficiency, while headache was the most common mass effect symptom. Although there was an overall female predominance for NFPAs, most macroadenomas were diagnosed in men. Furthermore, tumor size dictates the therapeutic management, with surgery being indicated mostly in macroadenomas.