{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:03:53Z","timestamp":1792242233365,"version":"4.4.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>An optimal surveillance plan of micro-nonfunctioning pituitary adenomas (micro-NFPAs) is not well established despite high prevalence and increasing incidence of these tumors. This study aims to characterize the natural history of conservatively treated micro-NFPAs and provide evidence for a management algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective, single center cohort study that analyzed clinical, hormonal and imaging data of conservatively managed micro-NFPAs (years 2018-2023).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>371 patients with micro-NFPAs were included in the study (mean age at diagnosis 41.26 \u00b1 13.71 years, 91.6% females) with a mean tumor size at detection of 5.51 \u00b1 1.95 mm. Over a median follow-up period of 4.8 years (IQR 2-8.64): 23.7% of all micro-NFPAs were stable, 41% regressed and 35.3% had any progression in size (34.5% of patients had a significant tumor growth, when considering 1 mm enlargement as significant, with a growth incidence of 17.18 per 100 person-years, 95% CI: 14.2- 20,15). The median growth was 1 mm (IQR: 0.5-2) over the entire follow up period and only 2.42% microadenomas evolved into macroadenomas, without clinical consequences. Sex, BMI, age were not predictors of tumor growth, however tumors smaller than 6 mm had a 47.4% higher incidence rate of significant tumor growth (\u2265 1mm) events per 100 person-years, compared to larger microadenomas. Alternating CT with MRI during follow-up is an important predictor for tumor variability. Median time until growth was 11.32 months (95%CI: 9.66- 12.97). At diagnosis, 1.1% had secondary hypogonadism, 1.1% hypothyroidism and 0.5% secondary hypoadrenalism. During follow-up, only 5 patients (1.3%) developed hypopituitarism after a median of 2 years (0.9-5.1), irrespective of tumor enlargement or other demographic and clinical factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Micro-NFPAs have an overall benign clinical course, with a high measuring variability in tumors smaller than 6 mm and hypopituitarism is a very rare occurrence. Performing the first follow-up MRI at one year and if stable, delaying re-evaluation to 5 years, without pituitary function reassessment in absence of clinical manifestations, is a safe and cost-effective approach.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1613239","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T04:11:01Z","timestamp":1754885461000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Long-term behaviour of non-functioning pituitary microadenomas: experience from a tertiary care centre in Romania"],"prefix":"10.3389","volume":"16","author":[{"given":"M\u0103d\u0103lina Elena","family":"Iftimie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iulia Florentina","family":"Burcea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona","family":"Dobre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Pigni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Prodam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lina","family":"Poian\u0103","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"B1","article-title":"Pituitary adenomas: an overview","volume":"88","author":"Lake","year":"2013","journal-title":"Am Fam Physician"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1177\/1179551420932921","article-title":"Contemporary management of clinically non-functioning pituitary adenomas: A clinical review","volume":"13","author":"AlMalki","year":"2020","journal-title":"Clin Med Insights Endocrinol Diabetes"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.7861\/clinmed.2023-0020","article-title":"Management of pituitary incidentalomas","volume":"23","author":"Westall","year":"2023","journal-title":"Clin Med (Lond)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20412","article-title":"The prevalence of pituitary adenomas: a systematic review","volume":"101","author":"Ezzat","year":"2004","journal-title":"Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2009.05.001","article-title":"Pituitary incidentalomas","volume":"23","author":"Molitch","year":"2009","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.02107","article-title":"Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data","volume":"154","author":"Buurman","year":"2006","journal-title":"Eur J Endocrinol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-120-10-199405150-00001","article-title":"Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population","volume":"120","author":"Hall","year":"1994","journal-title":"Ann Intern Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2020.04.002","article-title":"The epidemiology of pituitary adenomas","volume":"49","author":"Daly","year":"2020","journal-title":"Endocrinol Metab Clin North Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1210\/jc.2010-1048","article-title":"Endocrine Society. 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