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Clin Endocrinol (Oxf). 2018 Sep;89(3):354-359. doi: 10.1111/cen.13791. Epub 2018 Jul 11.

Long-term follow-up of a large prospective cohort of patients with nonfunctioning pituitary adenomas: The outcome of a conservative management policy.

Author information

1
Department of Diabetes & Endocrinology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK.

Abstract

OBJECTIVE:

To assess the clinical outcome of a strategy of conservative monitoring of patients with nonfunctioning pituitary adenomas (NFPA) after pituitary surgery and in patients without surgery.

DESIGN:

Retrospective study of outcomes, using a clinical information system.

PATIENTS:

An unselected, clinical series of patients seen in a single centre between 1989 and 2015.

MEASUREMENTS:

Review of clinical information system data to obtain details and dates of surgery, radiotherapy, pituitary imaging and outcomes.

RESULTS:

We identified 190 cases of NFPA. Trans-sphenoidal surgery (TSS) had been performed as primary therapy in 132 cases (all macro-adenomas). At a mean 7.6-years follow-up after TSS without immediate pituitary radiotherapy, recurrence occurred in 10.7% of cases with no visible postoperative residual adenoma, 38.8% with intrasellar and 66.7% with extrasellar residuum. Recurrence was defined as growth of residual tumour requiring intervention. On survival analysis, at 10 years, recurrence-free survival was 75% in patients with no residual tumour and 40% with intrasellar residuum. Recurrence occurred in 12.5% of 24 patients who had received postop radiotherapy. Patients were monitored conservatively without initial surgery in 65 patients. After a mean of 5-year monitoring, only 20% required intervention during follow-up (18.5% TSS) and 30.8% died of nonpituitary causes during follow-up.

CONCLUSION:

This study suggests that a conservative approach may be safe and appropriate in patients with NFPA if followed up with appropriate imaging surveillance, whether postoperative or without primary surgery.

KEYWORDS:

Non-functioning pituitary tumour; Null Cell pituitary tumour; Pituitary adenoma; Pituitary tumour; conservative management; radiotherapy

PMID:
29920729
DOI:
10.1111/cen.13791

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