Endocrine Abstracts

Non-functioning pituitary adenomas (NFPAs) are benign tumours not associated with clinical manifestations of hormonal hypersecretion. Based on population studies, their prevalence ranges between 7 and 41 per 100,000 people with the number of incidentally detected NFPAs increasing over the last decades. They cause clinical manifestations when they are large enough to exert pressure effects to surrounding structures. The initial management of non-apoplectic NFPAs depends mainly on their size and extensions. For microadenomas, imaging surveillance is advised; based on recent evidence, the first follow-up scan can be performed three years after the detection of the tumour due to the low probability of clinically relevant growth during this interval. Re-evaluation of the pituitary function is not required in the absence of microadenoma growth. Long-term studies clarifying safe duration of follow-up are not available. For macroadenomas managed conservatively, clinical, neuro-ophthalmological (if the tumour is in proximity with the optic pathways) and imaging monitoring are needed. Annual scanning is generally recommended for the first five years and this can be later extended if there is no evidence of enlargement. For operated NPFAs, clinical, neuro-ophthalmological (when relevant) and imaging monitoring are needed. The imaging protocol will mainly depend on extend of residual tumour, the administration of adjuvant radiotherapy and the presence of risk factors for aggressive tumour behaviour. In all cases, an earlier scan will be dictated by high index of suspicion of growth (e.g., visual field deficits) or clinical signs of apoplexy. Furthermore, monitoring of the hormonal replacement (when hypopituitarism is present) and regular assessment of the pituitary function (in patients offered radiotherapy) are required.