Endocrine Abstracts

Background: The clinical presentation of non-functioning pituitary adenomas (NFAs) can range from an incidental finding on imaging to pituitary hormone deficiencies and visual compromise.

Objective: To assess the clinical presentation of patients who had undergone surgical resection of histologically proven NFAs.

Methods: Patients presenting to the University Hospital of Wales, Cardiff, with non-functioning pituitary adenomas (histologically proven) between 2011-2019 were studied by examining biochemical, histological and radiological data.

Results: A total number of 209 patients with histologically-proven non-functioning pituitary macroadenomas were identified (130 male, 79 female). The mean age at surgery was 57yrs (range 24-86yrs). 81.9% patients presented symptomatically and 18.1% asymptomatically. In the total group:21.1% NFAs were found incidentally on brain imaging performed for another reason. 44/209 (21.1%) patients had their NFA diagnosed by an incidental field defect routinely at the optician (n = 21) or ophthalmology which they were attending for another reason (n = 23). In the symptomatic group: presenting complaints were reduced visual acuity (55.7%), headaches (38.3%), lethargy/tiredness (24.5%), reduced libido /erectile dysfunction (15.6%), visual field loss (10.8%) and galactorrhoea /menstrual disturbance (9%). 12 patients (7.2%) presented with pituitary apoplexy. The mean duration of symptoms before diagnosis was 16.9 months. 86.4% patients had chiasmal compression on imaging and 75.9% had visual field defects. 94 patients had pituitary hormone deficiencies. In the asymptomatic group: 75% had chiasmal compression and 52.8% had visual field defects. 21 asymptomatic patients had pituitary hormone deficiencies.

Conclusions: In our cohort of operated NFAs, 21.1% were found incidentally on brain imaging and routine visual field testing. Most patients presented symptomatically, commonly with visual symptoms or headaches, over a mean duration of 16.9 months. Given the cohort were operated NFAs, a large proportion had chiasmal compression and field defects. Of the asymptomatic patients, around half were found to have a visual field defect relating to chiasmal compression.