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Published on: January 17, 2018
UK practice on incidentally detected non-functioning pituitary microadenomas: analysis of two national surveys during
Ross Hamblin1,2,3, Athanasios Fountas1,2,3, Miles Levy4
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, IBR Tower, Level 2, Birmingham, B15 2TT, UK.
Purpose:
The optimal management approach for presumed non-functioning pituitary microadenomas (microNFPAs) remains unclear. Our aim was to capture current UK practice and identify changes with time.
Methods:
Two online surveys investigating clinicians' approaches were performed in 2009-2010 and 2021-2022 (advertised through Society for Endocrinology UK).
Results:
150 and 214 clinicians participated in the 2021 and 2009 survey, respectively (response rates 31.2% and 35.4%, respectively). At baseline, 2021 survey respondents were more likely to measure IGF-1 (96.0% vs 74.1%, p < 0.001) and morning cortisol (87.9% vs 62.6%, p < 0.001), and less likely GH (26.2% vs 42.6% p = 0.002), 24 h urine free cortisol (3.4% vs 23.2%, p < 0.0001) or dynamically assess adrenal reserve (11.4% vs 30.4%, p < 0.001). 47.2% of clinicians in 2021 would reassess pituitary function annually until discharge (in absence of tumour growth/symptoms). The 2021 survey respondents were more likely to stop imaging at or before 3 years (81.7% vs 44.3%, p < 0.001) and at or before 5 years (86.6.% vs 72.9%, p = 0.002), whilst 2009 survey respondents were more likely to continue imaging beyond 5 years (24% vs 7%, p < 0.001). Responses on imaging frequency/intervals showed notable variability in both surveys.
Conclusions:
Diagnostic and management approaches for microNFPAs have evolved in the UK. Biochemical investigations are performed in accord with consensus guidelines, though many clinicians perform annual biochemical surveillance without tumour growth/symptoms. A small number of clinicians request imaging beyond 5 years, but the frequency of imaging intervals until discharge remains variable. Robust evidence on the long-term natural history of microNFPAs is necessary to unify clinician approach.
Insights
Management of non-functioning pituitary microadenomas (microNFPAs) has evolved in the UK. While biochemical testing aligns with guidelines, annual surveillance and imaging practices vary, highlighting the need for evidence-based guidelines.
Area of Science:
- Endocrinology
- Neuroscience
- Oncology
Background:
- The optimal management strategy for presumed non-functioning pituitary microadenomas (microNFPAs) is not well-defined.
- Current UK clinical practice and its evolution over time require investigation.
Purpose of the Study:
- To assess current UK clinical practice for managing microNFPAs.
- To identify changes in management approaches over time.
Main Methods:
- Two online surveys were conducted in 2009-2010 and 2021-2022.
- Clinicians' diagnostic and management approaches for microNFPAs were investigated.
Main Results:
- Significant shifts in biochemical testing practices were observed between the two survey periods.
- Clinicians are now more likely to perform IGF-1 and morning cortisol measurements and less likely to measure GH or perform 24-hour urine free cortisol tests.
- Imaging frequency has decreased, with more clinicians stopping imaging by 3-5 years, though intervals remain variable.
- Annual biochemical surveillance is common even without tumor growth or symptoms.
Conclusions:
- UK management approaches for microNFPAs have evolved, with biochemical testing generally aligning with consensus guidelines.
- Variability persists in imaging frequency and biochemical surveillance intervals.
- Further research into the long-term natural history of microNFPAs is needed to standardize clinical practice.
