Endocrine Abstracts

Introduction: Clinically non-functioning pituitary tumors (NFPTs) lack clinical or biochemical evidence of pituitary hormone excess. Their clinical presentation is heterogeneous, including mass effect-related symptoms and/or hypopituitarism, or even no symptoms in incidentally-detected NFPTs. We aimed to evaluate the clinical presentation spectrum of NFPTs in a cohort of patients managed at our hospital.

Methods: Clinical, demographic, biochemical and imaging data from 227 patients was retrieved and retrospectively analyzed using SPSS®.

Results: Our cohort included 115 women (50.7%) and the median age of the study population was 58±15 years. Most patients had NFPT-related symptoms at presentation (75.3%), predominantly visual disturbances (56.8%) and headache (35.7%). In contrast, 56 patients (24.7%) had an incidental diagnosis on neuroimaging performed for other reasons, largely trauma (21.4%). Patients with incidentally-discovered NFPTs were significantly older than those with clinically-presenting NFPTs (62.8±14.2 vs 54.8±14.7; P=0.001). Regarding the entire group of patients, at diagnosis, the majority had one or more pituitary hormone deficiencies (55.9%), which occurred more frequently in men than women (66.1 vs 46.1%; P<0.001), in older patients and in patients with larger tumors (P<0.001). Of the 227 NFPTs, 210 (92.5%) were macroadenomas, and 180 (79.3%) had extrasellar extension. The mean diameter at diagnosis was 2.41±1.15 cm. Clinically-presenting patients had larger tumors (2.60 vs 1.97 cm; P=0.006). A total of 140 patients (61.7%) underwent surgery, 75.7% of these within the first 12 months since the NFPT diagnosis. The subgroup of incidentally-discovered NFPTs required less often an operation than the clinically-presenting counterparts (41.1 vs 68.4%; P<0.001).

Conclusion: Our NFPT cohort included patients who mostly presented with large tumors associated with compressive symptoms and hormonal deficiencies. However, a quarter of cases were incidentally-discovered NFPTs, typically found in older patients, and despite their smaller size still more than one third needed surgery.