{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:16:30Z","timestamp":1789186590416,"version":"build-2803163510"},"reference-count":26,"publisher":"Bioscientifica","issue":"12","license":[{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ec.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The incidental diagnosis of nonfunctioning pituitary macroadenomas (NFPMAs) is becoming more prevalent with the spread of modern brain imaging techniques. We sought to uncover new data about their natural history and surgical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a retrospective single-center observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Among 210 patients seen for a NFPMA between 2010 and 2019, 70 (33%) were discovered incidentally (i-NFPMA). We analyzed outcomes in a total of 65 patients with available follow-up data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age at diagnosis (\u00b1\n                      <jats:sc>s.d.<\/jats:sc>\n                      ) was 60 \u00b1 14 years and mean maximal diameter was 20.0 \u00b1 7.3 mm. At diagnosis, 29 patients (45%) had pituitary hormone deficits (LH\/FSH 41%, TSH 29%, ACTH 15%) and 12% had visual field deficits. 26 patients underwent initial surgery, while 12 had delayed surgery after initial surveillance. In the surveillance group, the risk of tumor growth was estimated at 10%\/year. Patients with hormonal deficits at diagnosis experienced earlier growth at 24 months (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.02). Overall, surgical resection of the i-NFPMA led to stable or improved endocrine function in 91% of patients, with only 6% postoperative permanent diabetes insipidus. Moreover, surgery was more effective in preserving intact endocrine function (10\/12) than restoring altered endocrine function to normal (6\/22,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>About one-third of NFPMAs are now discovered incidentally and a significant subset may be responsible for unrecognized endocrine and visual deficits. Under surveillance the risk of further tumor growth is significant (10%\/year) and seems to occur faster in patients already harboring an endocrine deficit. Early surgical removal before onset of endocrine deficits appears to lead to better endocrine outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-23-0224","type":"journal-article","created":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T09:53:35Z","timestamp":1696240415000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":12,"title":["Natural history and surgical outcome of incidentally discovered clinically nonfunctioning pituitary macroadenomas"],"prefix":"10.1530","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2665-9455","authenticated-orcid":true,"given":"Stefan M","family":"Constantinescu","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Duprez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Fomekong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Raftopoulos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orsalia","family":"Alexopoulou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0918-637X","authenticated-orcid":true,"given":"Dominique","family":"Maiter","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Best Practice and Research. Clinical Endocrinology and Metabolism","first-page":"101268","article-title":"Management of pituitary incidentaloma","volume":"33","author":"Boguszewski","year":"2019","unstructured":"Boguszewski CLde Castro Musolino NR & Kasuki L. Management of pituitary incidentaloma. Best Practice and Research. Clinical Endocrinology and Metabolism201933101268. (https:\/\/doi.org\/10.1016\/j.beem.2019.04.002)"},{"key":"bib2","series-title":"Indian Journal of Pathology and Microbiology","first-page":"692","article-title":"Prevalence of pituitary incidentaloma in the Iranian cadavers","volume":"54","author":"Aghakhani","year":"2011","unstructured":"Aghakhani KKadivar MKazemi-Esfeh SZamani NMoradi M & Sanaei-Zadeh H. Prevalence of pituitary incidentaloma in the Iranian cadavers. Indian Journal of Pathology and Microbiology201154692\u2013694. (https:\/\/doi.org\/10.4103\/0377-4929.91493)"},{"key":"bib3","series-title":"European Journal of Endocrinology","first-page":"753","article-title":"Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data","volume":"154","author":"Buurman","year":"2006","unstructured":"Buurman H & Saeger W. Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data. European Journal of Endocrinology2006154753\u2013758. (https:\/\/doi.org\/10.1530\/eje.1.02107)"},{"key":"bib4","series-title":"Annals of Internal Medicine","first-page":"817","article-title":"Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population","volume":"120","author":"Hall","year":"1994","unstructured":"Hall WALuciano MGDoppman JLPatronas NJ & Oldfield EH. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Annals of Internal Medicine1994120817\u2013820. (https:\/\/doi.org\/10.7326\/0003-4819-120-10-199405150-00001)"},{"key":"bib5","series-title":"European Journal of Endocrinology","first-page":"1","article-title":"Analysis and natural history of pituitary incidentalomas","volume":"175","author":"Imran","year":"2016","unstructured":"Imran SAYip CEPapneja NAldahmani KMohammad SImran FZwicker DATheriault CThompson KClarke DB, Analysis and natural history of pituitary incidentalomas. European Journal of Endocrinology20161751\u20139. (https:\/\/doi.org\/10.1530\/EJE-16-0041)"},{"key":"bib6","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"894","article-title":"Pituitary incidentaloma: an endocrine society clinical practice guideline","volume":"96","author":"Freda","year":"2011","unstructured":"Freda PUBeckers AMKatznelson LMolitch MEMontori VMPost KDLee Vance ML & Endocrine Society. Pituitary incidentaloma: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism201196894\u2013904. (https:\/\/doi.org\/10.1210\/jc.2010-1048)"},{"key":"bib7","series-title":"Hormone and Metabolic Research","first-page":"654","article-title":"Prevalence, clinical features, and natural history of incidental clinically non-functioning pituitary adenomas","volume":"49","author":"Iglesias","year":"2017","unstructured":"Iglesias PArcano KTrivi\u00f1o VGarc\u00eda-Sancho PD\u00edez JJVillabona C & Cordido F. Prevalence, clinical features, and natural history of incidental clinically non-functioning pituitary adenomas. Hormone and Metabolic Research201749654\u2013659. (https:\/\/doi.org\/10.1055\/s-0043-115645)"},{"key":"bib8","series-title":"Pituitary","first-page":"162","article-title":"Management of nonfunctioning pituitary adenomas (NFAs): observation","volume":"21","author":"Huang","year":"2018","unstructured":"Huang W & Molitch ME. Management of nonfunctioning pituitary adenomas (NFAs): observation. Pituitary201821162\u2013167. (https:\/\/doi.org\/10.1007\/s11102-017-0856-0)"},{"key":"bib9","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"905","article-title":"Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis","volume":"96","author":"Fern\u00e1ndez-Balsells","year":"2011","unstructured":"Fern\u00e1ndez-Balsells MMMurad MHBarwise AGallegos-Orozco JFPaul ALane MALampropulos JFNatividad IPerestelo-P\u00e9rez LDe Le\u00f3n-Lovat\u00f3n PGP, Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. Journal of Clinical Endocrinology and Metabolism201196905\u2013912. (https:\/\/doi.org\/10.1210\/jc.2010-1054)"},{"key":"bib10","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"4245","article-title":"Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: a metaanalysis","volume":"93","author":"Kazlauskaite","year":"2008","unstructured":"Kazlauskaite REvans ATVillabona CVAbdu TAMAmbrosi BAtkinson ABCheung CHClayton RNCourtney CHGonc EN, Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: a metaanalysis. Journal of Clinical Endocrinology and Metabolism2008934245\u20134253. (https:\/\/doi.org\/10.1210\/jc.2008-0710)"},{"key":"bib11","series-title":"Pituitary","first-page":"777","article-title":"Pituitary incidentalomas: analysis of a neuroradiological cohort","volume":"18","author":"Esteves","year":"2015","unstructured":"Esteves CNeves CAugusto LMenezes JPereira JBernardes IFonseca J & Carvalho D. Pituitary incidentalomas: analysis of a neuroradiological cohort. Pituitary201518777\u2013781. (https:\/\/doi.org\/10.1007\/s11102-015-0652-7)"},{"key":"bib12","series-title":"Intractable and Rare Diseases Research","first-page":"239","article-title":"Clinical investigation of pituitary incidentalomas: a two-center study","volume":"8","author":"Ishii","year":"2019","unstructured":"Ishii KAbe IKameda WSugimoto KMorinaga YIto MTakashi YAbe MHada YTakase K, Clinical investigation of pituitary incidentalomas: a two-center study. Intractable and Rare Diseases Research20198239\u2013244. (https:\/\/doi.org\/10.5582\/irdr.2019.01083)"},{"key":"bib13","series-title":"European Journal of Internal Medicine","first-page":"6","article-title":"The pituitary in nuclear medicine imaging","volume":"68","author":"Iglesias","year":"2019","unstructured":"Iglesias PCardona J & D\u00edez JJ. The pituitary in nuclear medicine imaging. European Journal of Internal Medicine2019686\u201312. (https:\/\/doi.org\/10.1016\/j.ejim.2019.08.008)"},{"key":"bib14","series-title":"Neuroendocrinology","first-page":"595","article-title":"Clinically nonfunctioning pituitary incidentalomas: characteristics and natural history","volume":"110","author":"Tresoldi","year":"2020","unstructured":"Tresoldi ASCarosi GBetella NDel Sindaco GIndirli RFerrante ESala EGiavoli CMorenghi ELocatelli M, Clinically nonfunctioning pituitary incidentalomas: characteristics and natural history. Neuroendocrinology2020110595\u2013603. (https:\/\/doi.org\/10.1159\/000503256)"},{"key":"bib15","series-title":"Journal of the Endocrine Society","first-page":"bvaa021","article-title":"Presenting features in 269 patients with clinically nonfunctioning pituitary adenomas enrolled in a prospective study","volume":"4","author":"Freda","year":"2020","unstructured":"Freda PUBruce JNKhandji AGJin ZHickman RAFrey EReyes-Vidal COtten MWardlaw SL & Post KD. Presenting features in 269 patients with clinically nonfunctioning pituitary adenomas enrolled in a prospective study. Journal of the Endocrine Society20204bvaa021. (https:\/\/doi.org\/10.1210\/jendso\/bvaa021)"},{"key":"bib16","series-title":"Endocrine Abstracts","first-page":"GP236.","article-title":"Characteristics and natural history of a large cohort of non-functioning pituitary incidentalomas: a two-centers study","volume":"63","author":"Betella","year":"2019","unstructured":"Betella NTresoldi ACarosi GSindaco Del GDLocatelli MMazziotti GMilani DMorenghi ESpada AArosio M, Characteristics and natural history of a large cohort of non-functioning pituitary incidentalomas: a two-centers study. Endocrine Abstracts201963GP236. (https:\/\/doi.org\/10.1530\/endoabs.63.GP236)"},{"key":"bib17","series-title":"Acta Neuropathology","first-page":"123","article-title":"A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case\u2013control study of 410 patients with 8 years post-operative follow-up","volume":"126","author":"Trouillas","year":"2013","unstructured":"Trouillas JRoy PSturm NDantony ECortet-Rudelli CViennet GBonneville JFAssaker RAuger CBrue T, A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case\u2013control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathology2013126123\u2013135. (https:\/\/doi.org\/10.1007\/s00401-013-1084-y)"},{"key":"bib18","series-title":"Pituitary","first-page":"545","article-title":"The experience with transsphenoidal surgery and its importance to outcomes","volume":"21","author":"Honegger","year":"2018","unstructured":"Honegger J & Grimm F. The experience with transsphenoidal surgery and its importance to outcomes. Pituitary201821545\u2013555. (https:\/\/doi.org\/10.1007\/s11102-018-0904-4)"},{"key":"bib19","series-title":"Clinical Endocrinology","first-page":"559","article-title":"Natural history of nonfunctioning pituitary macroadenomas followed without intervention: a retrospective cohort study","volume":"98","author":"Ayalon\u2010Dangur","year":"2023","unstructured":"Ayalon\u2010Dangur IRobenshtok EDuskin\u2010Bitan HTsvetov GGorshtein AAkirov A & Shimon I. Natural history of nonfunctioning pituitary macroadenomas followed without intervention: a retrospective cohort study. Clinical Endocrinology202398559\u2013566. (https:\/\/doi.org\/10.1111\/cen.14877)"},{"key":"bib20","series-title":"Endotext","article-title":"Non-Functioning Pituitary Adenomas","author":"Drummond","unstructured":"Drummond JB & Ribeiro-Oliveira ASB. Non-Functioning Pituitary Adenomas. In Endotext. Feingold KRAnawalt B & Boyce A, Eds. South Dartmouth, MA: MDText.com, Inc., 2022. (available at: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534880\/)"},{"key":"bib21","series-title":"Journal of Neurological Surgery","first-page":"672","article-title":"Developing an optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas","volume":"132","author":"Kim","year":"2019","unstructured":"Kim JHDho YSKim YHLee JHLee JHRam Hong A & Shin CS. Developing an optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas. Journal of Neurological Surgery2019132672. (https:\/\/doi.org\/10.3171\/2018.4.JNS172148)"},{"key":"bib22","series-title":"Pituitary","first-page":"71","article-title":"Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis","volume":"15","author":"Roelfsema","year":"2012","unstructured":"Roelfsema FBiermasz NR & Pereira AM. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis. Pituitary20121571\u201383. (https:\/\/doi.org\/10.1007\/s11102-011-0347-7)"},{"key":"bib23","series-title":"Presse Medicale","first-page":"104086","article-title":"Clinically non-functioning pituitary adenomas","volume":"50","author":"Chanson","year":"2021","unstructured":"Chanson P & Wolf P. Clinically non-functioning pituitary adenomas. Presse Medicale202150104086. (https:\/\/doi.org\/10.1016\/j.lpm.2021.104086)"},{"key":"bib24","series-title":"Journal of Neurosurgery","first-page":"545","article-title":"Endoscopic pituitary surgery: a systematic review and meta-analysis","volume":"111","author":"Tabaee","year":"2009","unstructured":"Tabaee AAnand VKBarr\u00f3n YHiltzik DHBrown SMKacker AMazumdar M & Schwartz TH. Endoscopic pituitary surgery: a systematic review and meta-analysis. Journal of Neurosurgery2009111545\u2013554. (https:\/\/doi.org\/10.3171\/2007.12.17635)"},{"key":"bib25","series-title":"European Journal of Endocrinology","first-page":"735","article-title":"Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients\u2019 characteristics","volume":"169","author":"Losa","year":"2013","unstructured":"Losa MDonofrio CABarzaghi R & Mortini P. Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients\u2019 characteristics. European Journal of Endocrinology2013169735\u2013742. (https:\/\/doi.org\/10.1530\/EJE-13-0515)"},{"key":"bib26","series-title":"Clinical Neurology and Neurosurgery","first-page":"2514","article-title":"Non-functioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic","volume":"115","author":"Messerer","year":"2013","unstructured":"Messerer MDubourg JRaverot GBervini DBerhouma MGeorge IChacko AGPerrin GLevivier MDaniel RT, Non-functioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic. Clinical Neurology and Neurosurgery20131152514\u20132520. 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