Endocrine Abstracts

Objective

The objective of this systematic review was to assess the incidence of growth, new pituitary endocrinopathies, and the incidence of surgery and/or radiotherapy in conservatively treated non-functioning pituitary adenomas/incidentalomas (NFPAs/NFPIs).

Method

A bibliographical search of Embase and Pubmed was conducted in order to identify eligible studies.

Results

33 Cohort studies including 1554 patients with a mean follow-up time of 3.8 years were extracted. During follow-up 482/1554 (31.02%) tumors grow corresponding to a risk of 6.4/100 (95% CI. 4.8 to 8.1; I² = 90) person years (py). Surgery was necessary in 136/1151 (11.82%) cases corresponding to a risk of 2.8/100py (95% CI. 1.9 to 3.4; I² = 58%). New endocrinopathies were observed in 76/901 (8.44%) patients corresponding to a risk of 1.4/100py (95% CI 0.7 to 2.1; I² = 74%). However, subgroup analysis suggested that growth of microadenomas occurred at a rate of 0.9/100 py (95% CI. 0.4 to 1.3; I² = 47%).

Conclusion

Conservatively treated NFPAs/NFPIs are in significant risk of growth, however, new endocrinopathies and active treatment is quite rare. Especially, the risk of growth in microadenomas was rarely observed. This, new evidence, supports differentiated follow-up protocols of NFPAs/NFPIs based on baseline tumuor size. However, the evidence was based on studies with methodological issues that need to be addressed in order to improve future decision making.