Radiological Assessment of Non-Functional Pituitary Adenomas

Background: Non-functional pituitary adenomas (NFPAs) are the most common form of pituitary neoplasia. A lack of clinical guidance relating to the frequency of radiological follow-up of NFPAs remains problematic both in tumours presenting clinically and incidentally. Post-operative disease recurrenceis achieved by annual assessment by magnetic resonance imaging for at least ten years to identify late disease recurrence. Objectives: Study the frequency and interval duration of MRI scans in patients with NFPAs to implement guidance for a cost effective scanning regime. Methods: Retrospective study was carried out in James Cook University Hospital, between 1993-2013, investigating all patients with NFPAs who were managed by a single surgeon. Eighty nine patients were identified from endocrine databases and theatre logbooks. Results: Seventy two NFPA patients were managed surgically and 17 were managed conservatively. Of the surgically managed subgroup, fifty nine patients had clear compression of the optic compression. The majority of NPFAs were diagnosed with a CT or MRI scan, 34 and 29, respectively. The overall mean time to achieve no change and tumour regrowth was significantly shorter in the conservatively managed patients, in comparison to the surgical group 1.2 vs 3.9 years and 0.9 vs 3.4 years, respectively. Seven hundred and fifteen scans were investigated. Conclusion: Late recurrence can occur in some patients, however it is uneconomical to carry out further scanning following steady state. Goldmann perimetry and serial hormone analysis may reduce health care costs once steady state has been achieved.