title: Clinical outcomes in patients with nonfunctioning pituitary adenomas managed conservatively.
abstract: BACKGROUND
  The natural history and the optimum management of patients with nonfunctioning pituitary adenomas (NFPAs) are unclear.
  
  
  OBJECTIVE
  Our objective was to characterize the natural history of patients with NFPAs managed conservatively.
  
  
  METHODS
  We conducted a retrospective analysis of patients presenting to a tertiary referral centre between 1986 and 2009. Patients with pituitary adenomas and no clinical or biochemical evidence of hormonal hypersecretion were included. Those presenting with apoplexy or a radiological follow-up period of less than 1 year were excluded. The pituitary imaging for all patients was re-examined by two neuroradiologists in consensus.
  
  
  METHODS
  The outcome measures were change in tumour size and pituitary hormone function.
  
  
  RESULTS
  Sixty-six patients were managed conservatively for a mean follow-up period of 4·3 years (range: 1-14·7). Forty-seven (71%) had a macroadenoma, and nineteen (29%) had a microadenoma. Tumour size decreased or remained stable in 40% of macroadenomas and 47% of microadenomas. The median annual growth rate of enlarging macroadenomas and microadenomas was 1·0 mm/year and 0·4 mm/year, respectively. The median annual growth rate of macroadenomas was significantly higher than that of microadenomas (P < 0·01). Sixty-eight percentage of patients with a macroadenoma had pituitary hormone deficiency in one or more axes, compared to 42% of those with a microadenoma.
  
  
  CONCLUSIONS
  Patients with NFPAs without optic chiasm compression can be managed conservatively. All patients need pituitary function assessment, irrespective of tumour size. These findings provide clinically relevant data for the management of patients with NFPAs.
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.|Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Sam
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Sachit
authors.initials: S
authors.lastname: Shah
authors.affiliation: Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Keenan
authors.initials: K
authors.lastname: Saleh
authors.affiliation: Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Jay
authors.initials: J
authors.lastname: Joshi
authors.affiliation: Division of Brain Sciences, Imperial College London, London, UK.
authors.forename: Federico
authors.initials: F
authors.lastname: Roncaroli
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Cox
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.|Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Martin
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Mendoza
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.|Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Meeran
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Amrish
authors.initials: A
authors.lastname: Mehta
authors.affiliation: Imperial College Healthcare NHS Trust, London, UK.|Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Waljit S
authors.initials: WS
authors.lastname: Dhillo
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D057832:Watchful Waiting