Clinician decision-making in non-functioning pituitary adenomas: an Australian and New Zealand interdisciplinary...

Non-functioning pituitary adenomas (NFPA) are one of the most frequent pituitary adenoma subtypes, yet dedicated management guidelines do not exist. This study aimed to characterise real-world clinical decision-making across the spectrum of NFPA presentations and to identify areas of practice conformity versus heterogeneity within and between specialty groups.

A cross-sectional, anonymous electronic survey was administered to endocrinologists, neurosurgeons, ENT surgeons, and radiation oncologists involved in pituitary adenoma care in Australia and New Zealand between January and April 2025. Three clinical scenarios were presented: an incidental microadenoma, an incidental asymptomatic macroadenoma, and a symptomatic macroadenoma with visual compromise. Concordance was defined as greater than 70% agreement on a single response within any group.

A total of 145 clinicians completed the survey (99 endocrinologists, 31 surgeons, 15 radiation oncologists). Areas of conformity included broad anterior pituitary hormonal evaluation, conservative management of incidental asymptomatic macroadenomas, and active intervention for symptomatic disease with visual loss. Significant heterogeneity was identified in ophthalmological assessment, repeat imaging intervals, post-operative MRI and visual field timing, and multidisciplinary team (MDT) meeting referral rates. Compared to general endocrinologists, pituitary subspecialty endocrinologists were significantly more likely to refer patients for MDT discussion and know the caseload of the surgeon to whom they were referring, and less likely to measure serum cortisol immediately post-operatively.

This survey identifies clinically important variation in NFPA management, concentrated in domains lacking guideline recommendations. These findings highlight the need for dedicated NFPA guidelines spanning the full spectrum of NFPA presentations.