Developing an optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas

Abstract

OBJECTIVE The natural history and proper algorithm for follow-up testing of nonfunctioning pituitary adenomas (PAs) are not well known, despite their relatively high prevalence. The aim of this study was to suggest the optimal follow-up algorithm for nonfunctioning PAs based on their natural history. METHODS The authors followed up 197 patients with nonfunctioning PAs that had not been treated (including surgery and radiation therapy) at the time of detection, in a single center, between March 2000 and February 2017. They conducted a hormone test, visual field test, and MRI at the time of diagnosis and yearly thereafter. RESULTS The overall median follow-up duration was 37 months. Microadenomas (n = 38) did not cause visual disturbance, pituitary apoplexy, or endocrine dysfunction. The incidence of patients with tumor volume growth ≥ 20% was higher for macroadenomas than microadenomas (13.8 vs 5.0 per 100 person-years [PYs], p = 0.002). The median time to any tumor growth was 4.8 years (95% CI 3.4-4.8 years) for microadenomas and 4 years (95% CI 3.3-4.2 years) for macroadenomas. The overall incidence of worsening visual function was 0.69 per 100 PYs. Patients with a tumor volume growth rate ≥ 0.88 cm/year (n = 20) had a higher incidence of worsening visual function (4.69 vs 0.30 per 100 PYs, p < 0.001). The tumor growth rate of all microadenomas was < 0.88 cm/year. The median time to tumor growth ≥ 20% was 3.3 years (95% CI 1.8-3.9 years) in patients with a tumor growth rate ≥ 0.88 cm/year and 4.9 years (95% CI 4.6-7.2 years) in patients with a tumor growth rate < 0.88 cm/year. CONCLUSIONS The authors have devised a follow-up strategy based on the tumor volume growth rate as well as initial tumor volume. In patients with microadenomas, the next MRI study can be performed at 3 years. In patients with macroadenomas, the second MRI study should be performed between 6 months and 1 year to assess the tumor growth rate. In patients with a tumor growth rate ≥ 0.88 cm/year, the MRI study should be performed within 2 years. In patients with a tumor growth rate < 0.88 cm/year, the MRI study can be delayed until 4 years.

Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic—an international perspective

“…Selected patients with slowly progressive visual loss, functioning tumors with aggressive clinical features, and those with an unclear diagnosis, may also benefit from urgent (but not emergent) surgery, with decisions made on a case-by-case basis. Patients with incidental and asymptomatic tumors, known nonfunctioning adenomas [7] or functioning tumors, which are well controlled with medical therapy, can be scheduled as elective cases.…”

Epigenetic Dysregulation in Pituitary Tumors

“…With the exception of prolactinomas, which are treated with dopamine agonists, most pituitary tumors undergo surgical resection as first-line treatment [67]. Approximately 80% of nonfunctioning and GH-secreting and 25% of PRL-secreting adenomas are macroadenomas (≥1 cm in diameter) at presentation [68]. These tumors often invade surrounding structures, including the cavernous sinus or dura mater, and incomplete resection is common with reported cure rates of 30%, even in specialized centers [69].…”

Pituitary non-functioning macroadenomas: If and when to recommend surgery

“…If non-secretor microadenomas may be assessed every 1 year and then every 2-3 years, the first assessment for a macroadenoma is needed after 6 months during the first 2-3 years and then yearly if the tumour is stationary (20,21). One study found that a volume growth more than 0.88 cm3/year at magnetic resonance imagery allows the rescan after 2 years while less than mentioned cut off indicates a rescan after 4 years (22). The natural history of pituitary macroadenomas conservatory treated is still a heterogeneous topic (20)(21)(22).…”

“…One study found that a volume growth more than 0.88 cm3/year at magnetic resonance imagery allows the rescan after 2 years while less than mentioned cut off indicates a rescan after 4 years (22). The natural history of pituitary macroadenomas conservatory treated is still a heterogeneous topic (20)(21)(22).…”