Pituitary Adenoma Natural History

Pituitary Adenoma Natural History

Pituitary adenomas (PAs) are often detected as incidentalfindings. However, the natural history remains unclear. The objective of a study of Hwang et al., was to evaluate the natural history and growth pattern of untreated PAs.

Between 2003 and 2014, 59 PAs were managed with clinico-radiological follow up for longer than 12 months without any kind of therapeutic interventionTumor volumes were calculated at initial and last follow-up visit, and tumor growth during the observation period was determined. Data were analyzed according to clinical and imaging characteristics.

The mean initial and last tumor volume and diameter were 1.83±2.97 mL and 13.77±6.45 mm, 2.85±4.47 mL and 15.75±8.08 mm, respectively. The mean annual tumor growth rate was 0.33±0.68 mL/year during a mean observation period of 46.8±32.1 months. Sixteen (27%) PAs showed tumor growth. The initial tumor size (HR, 1.140; 95% confidence interval, 1.003-1.295; p=0.045) was the independent predictive factor that determined the tumor growth. Six patients (11%) of 56 conservatively managed non-symptomatic PAs underwent resection for aggravating visual symptoms with mean interval of 34.5 months from diagnosis. By Cox regression analysis, PAs of last longest diameter over 21.75 mm were a significant prognostic factor for eventual treatment.

The initial tumor size of PAs was independently associated with the tumor growth. Six patients (11%) of conservatively managed PAs were likely to be treated eventually. PAs of last follow-up longest diameter over 21.75 mm were a significant prognostic factor for treatment. Further studies with a large series are required to determine treatment strategy 1).


Despite the relatively high prevalence of pituitary incidentalomas (PIs)/nonfunctioning pituitary adenomas (NFPAs), the evidence on the natural history of these entities is scarce and of low quality. PIs/NFPAs seem to have fairly rare complications that may be more common when lesions are large (>10 mm) and solid 2).


The ‘watch and wait’ policy seems reasonable for microadenomas but is probably not a safe approach for macroadenomas, which appear to have a significant growth potential; in these cases, given the lack of established medical treatment, the decision for surgical intervention should balance the presence of significant comorbidities and the anaesthetic/peri-operative risks at presentation against the probability of tumour enlargement and its consequences, as well as the possible loss of advantages associated with early operation 3).

References

1)

Hwang K, Kwon T, Park J, Joo JD, Han JH, Oh CW, Kim CY. Growth Pattern and Prognostic Factors of Untreated Nonfunctioning Pituitary Adenomas. J Korean Neurosurg Soc. 2019 Mar;62(2):256-262. doi: 10.3340/jkns.2018.0153. Epub 2019 Feb 27. PubMed PMID: 30840981.
2)

Fernández-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Pérez L, Ponce de León-Lovatón PG, Erwin PJ, Carey J, Montori VM. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011 Apr;96(4):905-12. doi: 10.1210/jc.2010-1054. Review. PubMed PMID: 21474687.
3)

Karavitaki N, Collison K, Halliday J, Byrne JV, Price P, Cudlip S, Wass JA. What is the natural history of nonoperated nonfunctioning pituitary adenomas? Clin Endocrinol (Oxf). 2007 Dec;67(6):938-43. Epub 2007 Aug 13. PubMed PMID: 17692109.

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