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

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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 cm3/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 cm3/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 cm3/year and 4.9 years (95% CI 4.6–7.2 years) in patients with a tumor growth rate < 0.88 cm3/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 cm3/year, the MRI study should be performed within 2 years. In patients with a tumor growth rate < 0.88 cm3/year, the MRI study can be delayed until 4 years.

ABBREVIATIONS ACTH = adrenocorticotropic hormone; FSH = follicle-stimulating hormone; LH = luteinizing hormone; PA = pituitary adenoma; PY = person-year; TSH = thyroid-stimulating hormone; VIS = visual impairment scale.

Article Information

Correspondence Yong Hwy Kim: Seoul National University Hospital, Seoul, Republic of Korea. kimyh96@snu.ac.kr.

INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.4.JNS172148.

J.H.K. and Y.S.D. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Natural course of 197 patients with nonfunctioning pituitary adenomas.

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    Kaplan-Meier survival curve for probability of any growth according to initial tumor size.

References

  • 1

    Agustsson TTBaldvinsdottir TJonasson JGOlafsdottir ESteinthorsdottir VSigurdsson G: The epidemiology of pituitary adenomas in Iceland, 1955–2012: a nationwide population-based study. Eur J Endocrinol 173:6556642015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Arita KTominaga ASugiyama KEguchi KIida KSumida M: Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination. J Neurosurg 104:8848912006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Daly AFRixhon MAdam CDempegioti ATichomirowa MABeckers A: High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 91:476947752006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Day PFGuitelman MArtese RFiszledjer LChervin AVitale NM: Retrospective multicentric study of pituitary incidentalomas. Pituitary 7:1451482004

  • 5

    Dekkers OMHammer Sde Keizer RJRoelfsema FSchutte PJSmit JW: The natural course of non-functioning pituitary macroadenomas. Eur J Endocrinol 156:2172242007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Donovan LECorenblum B: The natural history of the pituitary incidentaloma. Arch Intern Med 155:181–1831995

  • 7

    Fahlbusch RSchott W: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:2352432002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Feldkamp JSanten RHarms EAulich AMödder UScherbaum WA: Incidentally discovered pituitary lesions: high frequency of macroadenomas and hormone-secreting adenomas—results of a prospective study. Clin Endocrinol (Oxf) 51:1091131999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Fernandez AKaravitaki NWass JA: Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf) 72:3773822010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Fernández-Balsells MMMurad MHBarwise AGallegos-Orozco JFPaul ALane MA: Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 96:9059122011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Freda PUBeckers AMKatznelson LMolitch MEMontori VMPost KD: Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96:8949042011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Imran SAYip CEPapneja NAldahmani KMohammad SImran F: Analysis and natural history of pituitary incidentalomas. Eur J Endocrinol 175:192016

  • 13

    Jung KWHa JLee SHWon YJYoo H: An updated nationwide epidemiology of primary brain tumors in republic of Korea. Brain Tumor Res Treat 1:16232013

  • 14

    Karamouzis IBerardelli RPrencipe NBerton ABona CStura G: Retrospective observational analysis of non-irradiated non-functioning pituitary adenomas. J Endocrinol Invest 38:119111972015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Lenders NIkeuchi SRussell AWHo KKPrins JBInder WJ: Longitudinal evaluation of the natural history of conservatively managed nonfunctioning pituitary adenomas. Clin Endocrinol (Oxf) 84:2222282016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Molitch ME: Diagnosis and treatment of pituitary adenomas: a review. JAMA 317:5165242017

  • 17

    Murad MHFernández-Balsells MMBarwise AGallegos-Orozco JFPaul ALane MA: Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clin Endocrinol (Oxf) 73:7777912010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Nishizawa SOhta SYokoyama TUemura K: Therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”). Neurosurgery 43:134413501998

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Reincke MAllolio BSaeger WMenzel JWinkelmann W: The ‘incidentaloma’ of the pituitary gland. Is neurosurgery required? JAMA 263:277227761990

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Sanno NOyama KTahara STeramoto AKato Y: A survey of pituitary incidentaloma in Japan. Eur J Endocrinol 149:1231272003

  • 21

    Tjörnstrand AGunnarsson KEvert MHolmberg ERagnarsson ORosén T: The incidence rate of pituitary adenomas in western Sweden for the period 2001–2011. Eur J Endocrinol 171:5195262014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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