{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T21:26:53Z","timestamp":1775251613072,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Increased frequency of neuroimaging has led to enhanced identification of small nonfunctioning pituitary adenomas (NFPAs) leading, in many cases, to extensive follow-up. However, the value of ongoing monitoring of these incidental lesions remains unclear. The study aims to determine the need for surgical intervention and assess the risks of developing new endocrinopathies during follow-up in patients with conservatively treated micro-NFPAs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A systematic review and individual participant data (IPD) meta-analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a bibliographical search of PubMed and EMBASE to identify relevant studies. Authors of eligible studies were invited to share IPD. Cohort studies including patients with conservatively treated micro-NFPAs with at least 1 follow-up magnetic resonance imaging were considered eligible. Fourteen studies met inclusion criteria. Six authors provided IPD (N = 647). Data were reanalyzed for verification. In cases of discrepancies the original authors were contacted for authentication.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Risk estimates were reported as number of events per 100 person-years (PYs). Estimates were pooled using the 2-step approach. Overall probability of surgery was 0.2\/100 PYs (95% CI: 0.0-0.4; I2 = 28%). Probability of surgery due to visual impairment was 0.1\/100 PYs (95% CI: 0.0-0.2; I2 = 0%). Both were independent of baseline tumor size (\u22656 or &amp;lt;6\u2005mm), sex, or age (P values &amp;gt;.40). Risk of developing a new endocrinopathy was 1.0\/100 PYs (95% CI: 0.4-1.6; I2 = 0%). Data for classical meta-analysis were available for 7 studies (N = 1089) and supported the IPD results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These data suggest that routine follow-up of micro-NFPAs can be reduced significantly and that available guidelines should be revisited.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf189","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T17:31:14Z","timestamp":1758562274000},"page":"S61-S70","source":"Crossref","is-referenced-by-count":2,"title":["Natural history of nonfunctioning pituitary microadenomas: a systematic review and individual participant data meta-analysis"],"prefix":"10.1093","volume":"193","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2792-6738","authenticated-orcid":false,"given":"Victor B","family":"Boesen","sequence":"first","affiliation":[{"name":"Clinic for Pituitary Disorders, Department of Medicine, Zealand University Hospital , 4600 K\u00f8ge ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tue H","family":"Hansen","sequence":"additional","affiliation":[{"name":"Clinic for Pituitary Disorders, Department of Medicine, Zealand University Hospital , 4600 K\u00f8ge ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , 2200 Copenhagen ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Motawea","sequence":"additional","affiliation":[{"name":"Clinic for Pituitary Disorders, Department of Medicine, Zealand University Hospital , 4600 K\u00f8ge ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9284-6289","authenticated-orcid":false,"given":"Maria","family":"Fleseriu","sequence":"additional","affiliation":[{"name":"Pituitary Center, Department of Neurological Surgery and Department of Medicine, Oregon Health & Science University , Portland, OR 97239-3098 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena V","family":"Varlamov","sequence":"additional","affiliation":[{"name":"Pituitary Center, Department of Neurological Surgery and Department of Medicine, Oregon Health & Science University , Portland, OR 97239-3098 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9303-9742","authenticated-orcid":false,"given":"Ashley J","family":"Han","sequence":"additional","affiliation":[{"name":"Pituitary Center, Department of Neurological Surgery and Department of Medicine, Oregon Health & Science University , Portland, OR 97239-3098 ,","place":["United States"]},{"name":"Department of Internal Medicine, Mayo Clinic , Rochester, MN 55905 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed A","family":"Imran","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Dalhousie University , Halifax, NS , B3H 2Y9","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicki","family":"Munro","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Dalhousie University , Halifax, NS , B3H 2Y9","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Alenazi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Dalhousie University , Halifax, NS , B3H 2Y9","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warrick J","family":"Inder","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, QLD 4102 ,","place":["Australia"]},{"name":"Faculty of Medicine, The University of Queensland , Brisbane, QLD 4072 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6738-0832","authenticated-orcid":false,"given":"Nele","family":"Lenders","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, St Vincent's Hospital , Sydney, NSW 2010 ,","place":["Australia"]},{"name":"Garvan Institute of Medical Research , Sydney, NSW 2010 ,","place":["Australia"]},{"name":"St Vincent's Clinical School, University of New South Wales , Sydney, NSW 2052 ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana A","family":"Damilano","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda, Sanatorio Allende , X5000BFB C\u00f3rdoba ,","place":["Argentina"]},{"name":"Departamento de Neuroendocrinolog\u00eda de la Sociedad de Endocrinolog\u00eda y Metabolismo de C\u00f3rdoba (SEMCO), X5000HWJ C\u00f3rdoba ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia L","family":"Monteserin","sequence":"additional","affiliation":[{"name":"Departamento de Neuroendocrinolog\u00eda de la Sociedad de Endocrinolog\u00eda y Metabolismo de C\u00f3rdoba (SEMCO), X5000HWJ C\u00f3rdoba ,","place":["Argentina"]},{"name":"Servicio de Endocrinolog\u00eda, Cl\u00ednica Universitaria Reina Fabiola , X5004FHP C\u00f3rdoba ,","place":["Argentina"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5380-2141","authenticated-orcid":false,"given":"Andrea G","family":"Lania","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University , 20072 Pieve Emanuele, Milan ,","place":["Italy"]},{"name":"Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital , 20089 Rozzano, Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Carosi","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico , 20122 Milan ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, University of Milan , 20122 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9065-3886","authenticated-orcid":false,"given":"Giovanna","family":"Mantovani","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico , 20122 Milan ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, University of Milan , 20122 Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawid","family":"Hordejuk","sequence":"additional","affiliation":[{"name":"Rush Medical College, Rush University , Chicago, IL 60612 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9126-1948","authenticated-orcid":false,"given":"Le","family":"Min","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursula B","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan D","family":"Rikvold","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet , 2200 Copenhagen 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