Conservative Monitoring Strategy for Non-Functioning Pituitary Adenomas Evaluated

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Patients with a visible residual extra-sellar tumor were more likely to experience recurrence than patients with intra-sellar disease.
Patients with a visible residual extra-sellar tumor were more likely to experience recurrence than patients with intra-sellar disease.

According to a study published in Clinical Endocrinology, conservative prospective monitoring is a safe and effective alternative to repeat surgery or radiation therapy in patients with non-functioning pituitary adenoma, particularly when followed up with appropriate imaging surveillance.

In this long-term follow-up of a large prospective cohort study, researchers assessed the clinical outcomes of a conservative monitoring policy employed by a UK endocrine provider between 1989 and 2015. The primary outcome was disease recurrence, which researchers defined as the growth of residual tumor requiring intervention.

Of the 190 patients (median age 61.2 at diagnosis) with non-functioning pituitary adenomas who were included in the study, 132 underwent trans-sphenoidal surgery as their primary treatment. Following a mean follow-up period of 7.6 years without immediate pituitary radiotherapy, 10.7% of these patients experienced recurrence with no visible post-operative residual adenoma, 38.8% experienced recurrence with intrasellar residuum, and 66.7% experienced recurrence with extrasellar residuum. Based on these statistics, researchers determined that the main predictive post-operative factor for further tumor growth was “the degree to which the post-operative residuum extended beyond the sella.”

There were 65 participants in the monitoring program, known as Primary Conservative Monitoring. During a mean period of 5 years, only 20% of patients monitored required intervention (18.5% trans-sphenoidal surgery) and 30.8% died of non-pituitary causes.

Researchers highlighted certain study limitations, including the absence of a control population that might have mitigated confounding variables.

“From a practical clinical perspective we can be certain that over 30% of the primary conservative monitoring cohort had no new pressure effects from their pituitary macro-adenoma during their lifetime,” the researchers said, adding, “and on that basis any pituitary surgery recommended at diagnosis would have been unnecessary, thus validating the conservative monitoring approach.”

Reference

Levy M, Robertson I, Khalk N, et al. Long-term follow up of a large prospective cohort of patients with non-functioning pituitary adenomas: the outcome of a conservative management policy [published online June 19, 2018] Clin Endocrinol (Oxf). doi:10.1111/cen.13791

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