Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History
Alberto Stefano Tresoldi, Giulia Carosi, Nazarena Betella, Giulia Del Sindaco, Rita Indirli, Emanuele Ferrante, Elisa Sala, Claudia Giavoli, Emanuela Morenghi, Marco Locatelli, Davide Milani, Gherardo Mazziotti, Anna Spada, Maura Arosio, Giovanna Mantovani, Andrea Gerardo Antonio Lania, Alberto Stefano Tresoldi, Giulia Carosi, Nazarena Betella, Giulia Del Sindaco, Rita Indirli, Emanuele Ferrante, Elisa Sala, Claudia Giavoli, Emanuela Morenghi, Marco Locatelli, Davide Milani, Gherardo Mazziotti, Anna Spada, Maura Arosio, Giovanna Mantovani, Andrea Gerardo Antonio Lania
Abstract
Introduction: Available data on pituitary incidentalomas mostly derive from small-scale studies, with heterogeneous inclusion criteria and limited follow-up. No paper has focused specifically on clinically nonfunctioning pituitary in-cidentalomas (CNFPIs).
Objective: To describe the charac-teristics and the natural history of patients diagnosed with CNFPIs.
Methods: Retrospective multicenter cohort study evaluating hormonal, imaging, and visual field characteristics at diagnosis and during follow-up of CNFPIs investigated in 2 Pituitary Centers.
Results: Three hundred and seventy-one patients were included (50.9% microadenomas, 35.6% males). Men were older and more likely to have a macroadenoma (p < 0.01). Totally, 23.7% of patients presented secondary hormonal deficits (SHDs), related to tumor size (higher in macroadenomas; p < 0.001) and age (higher in older patients; p < 0.001). Hypogonadism was the most frequent SHD (15.6%). Two hundred and ninety-six patients had follow-up data, 29.1% required surgery after first evaluation, and 97 had at least 3 years of follow-up. In total, 15.3% adenomas grew (more macroadenomas), but only in microadenomas patients with longer follow-up showed a higher growth trend. Totally, 5.2% of patients developed new SHDs (micro- vs. macroadenomas p = 1.000), and in 60% of them this was not associated with an increase in tumor size. Thirteen additional patients required surgery during follow-up (1 microadenoma at diagnosis).
Conclusions: Macroadenomas and age are risk factors for SHD in CNFPIs, which occur at diagnosis in a quarter of patients. During follow-up, macroadenomas tend to grow more often, but microadenomas display higher growth trend as follow-up increases. Deterioration of pituitary function is not always related to adenoma growth.
Keywords: Hypopituitarism; Natural history; Nonfunctional pituitary adenomas; Nonfunctioning pituitary incidentalomas; Pituitary incidentaloma.
© 2020 S. Karger AG, Basel.
Source: PubMed