Athanasios Fountas, Kirstie Lithgow, Paul Benjamin Loughrey, Efstathios Bonanos, Shah Khalid Shinwari, Kirsten Mitchell, Akash Mavilakandy, Masato Ahsan, Mike Matheou, Kristina Isand, Ross Hamblin, David S McLaren, Hafiz Zubair Ullah, Lydia Grixti, James MacFarlane, Anuradha Jayasuriya, Sumbal Bhatti, Wunna Wunna, Syed Shah, Ziad Hussein, Susan Mathew, Katarina Klaucane, John Ayuk, Andy Toogood, Georgios Tsermoulas, Shahzada Ahmed, Alessandro Paluzzi, Ruchika Batra, Joannis Vamvakopoulos, Amutha Krishnan, Claire Higham, Prakash Abraham, Stephanie E Baldeweg, Tejpal Purewal, Janki Panicker, Niamh Martin, William M Drake, Rupa Ahluwalia, John Newell-Price, Mark Gurnell, Yaasir Mamoojee, Antonia Brooke, Andrew Lansdown, Robert D Murray, Karin Bradley, Aparna Pal, Narendra Reddy, Miles J Levy, Ellen Marie Freel, Biju Jose, Steven J Hunter, Niki Karavitaki
{"title":"保守管理的无功能垂体大腺瘤——来自英国无功能垂体腺瘤协会的队列研究。","authors":"Athanasios Fountas, Kirstie Lithgow, Paul Benjamin Loughrey, Efstathios Bonanos, Shah Khalid Shinwari, Kirsten Mitchell, Akash Mavilakandy, Masato Ahsan, Mike Matheou, Kristina Isand, Ross Hamblin, David S McLaren, Hafiz Zubair Ullah, Lydia Grixti, James MacFarlane, Anuradha Jayasuriya, Sumbal Bhatti, Wunna Wunna, Syed Shah, Ziad Hussein, Susan Mathew, Katarina Klaucane, John Ayuk, Andy Toogood, Georgios Tsermoulas, Shahzada Ahmed, Alessandro Paluzzi, Ruchika Batra, Joannis Vamvakopoulos, Amutha Krishnan, Claire Higham, Prakash Abraham, Stephanie E Baldeweg, Tejpal Purewal, Janki Panicker, Niamh Martin, William M Drake, Rupa Ahluwalia, John Newell-Price, Mark Gurnell, Yaasir Mamoojee, Antonia Brooke, Andrew Lansdown, Robert D Murray, Karin Bradley, Aparna Pal, Narendra Reddy, Miles J Levy, Ellen Marie Freel, Biju Jose, Steven J Hunter, Niki Karavitaki","doi":"10.1093/ejendo/lvaf091","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium.</p><p><strong>Design: </strong>This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments.</p><p><strong>Methods: </strong>Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed.</p><p><strong>Results: </strong>Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%).</p><p><strong>Conclusions: </strong>Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment.</p>","PeriodicalId":11884,"journal":{"name":"European Journal of Endocrinology","volume":" ","pages":"680-690"},"PeriodicalIF":5.3000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary Adenoma Consortium.\",\"authors\":\"Athanasios Fountas, Kirstie Lithgow, Paul Benjamin Loughrey, Efstathios Bonanos, Shah Khalid Shinwari, Kirsten Mitchell, Akash Mavilakandy, Masato Ahsan, Mike Matheou, Kristina Isand, Ross Hamblin, David S McLaren, Hafiz Zubair Ullah, Lydia Grixti, James MacFarlane, Anuradha Jayasuriya, Sumbal Bhatti, Wunna Wunna, Syed Shah, Ziad Hussein, Susan Mathew, Katarina Klaucane, John Ayuk, Andy Toogood, Georgios Tsermoulas, Shahzada Ahmed, Alessandro Paluzzi, Ruchika Batra, Joannis Vamvakopoulos, Amutha Krishnan, Claire Higham, Prakash Abraham, Stephanie E Baldeweg, Tejpal Purewal, Janki Panicker, Niamh Martin, William M Drake, Rupa Ahluwalia, John Newell-Price, Mark Gurnell, Yaasir Mamoojee, Antonia Brooke, Andrew Lansdown, Robert D Murray, Karin Bradley, Aparna Pal, Narendra Reddy, Miles J Levy, Ellen Marie Freel, Biju Jose, Steven J Hunter, Niki Karavitaki\",\"doi\":\"10.1093/ejendo/lvaf091\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium.</p><p><strong>Design: </strong>This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments.</p><p><strong>Methods: </strong>Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed.</p><p><strong>Results: </strong>Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%).</p><p><strong>Conclusions: </strong>Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment.</p>\",\"PeriodicalId\":11884,\"journal\":{\"name\":\"European Journal of Endocrinology\",\"volume\":\" \",\"pages\":\"680-690\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Endocrinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ejendo/lvaf091\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ejendo/lvaf091","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary Adenoma Consortium.
Objective: Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium.
Design: This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments.
Methods: Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed.
Results: Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%).
Conclusions: Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment.
期刊介绍:
European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica.
The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology.
Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials.
Equal consideration is given to all manuscripts in English from any country.