Endocrine Abstracts

Nonfunctioning pituitary adenomas (NFAs) have no symptoms of hormonal overproduction and can be asymptomatic or have severe symptoms due to mass effects. The aim of our study was to assess clinical features and therapeutic outcomes in patients with clinically NFAs. We retrospectively collected data of 175 patients from 3 hospitals of Buenos Aires. Mean age: 51 years (r:13–90), 52% women, mean follow-up: 7.37 years. At diagnosis, clinical presentation was: visual field defects (VFD) 42%, headache 24%, incidentaloma 23%, hypopituitarism 8%; tumor size: macroadenomas 94% (17% giant adenomas). Surgery was performed in 132 patients (75%), transsphenoidal approach in 78%. The remaining patients were closely followed up. Radiotherapy was performed after surgery in 22%. Operated patients had larger tumors (31 ± 11 vs 18 ± 9 mm, P < 0.000), more VFD (80 vs 40%, P < 0.000) and hormonal deficiencies (70 vs 42%, p:0.002) compared with non-operated patients; no age differences between the groups. In operated patients, tumor type: gonadotroph 63%, null cell 26%, silent GH 3%, silent PRL 2%, plurihormonal 1% and silent ACTH 1%. Ki67 was available in 49%: < 3%: 77%, between 3–10%: 23%; positive P53 in 23%, positive cytokeratin in 85%. After surgery: 16% of patients presented empty sella, tumor size reduction was > 50% in 30%, the remaining had < 50% tumor reduction. VFD improved in 42%, no change in 49% and worsened in 9%. Hormonal axes improved in 12%, no change in 50%, added deficiencies: 37%. Of 132 operated patients, 86 underwent only 1 surgery, 46 had more surgeries. In non-operated patients tumor size was stable in 82.5%, reduced in 12.5% and increased in 5%; VFD had no changes in 92.5%, improved in 7.5%; hormonal deficiencies had no changes in 95%, improved in 5%. Comparing operated and non-operated patients, the first showed more improvement in VFD (47 vs 18%, P:0.03) and tumor size (80 vs 12.5%, P < 0.000). Operated patients, had significantly more hormonal deficiencies (40 vs 0%, P:0.001). No correlation was found between VFD and age or sex. Kaplan–Meier analysis showed no significant differences in progression between operated and non-operated patients.

Conclusions

In patients with NFAs, surgery was the first therapeutic option, radiotherapy was performed in only 22%. Operated patients presented improvement in VFD but added hormonal deficiencies. Close follow-up of non-operated patients was preferred in smaller tumors.