Early Surgical Intervention in Nonfunctioning Pituitary Macroadenomas in Adult Patients without Optic Apparatus Compression—Should We Consider It? A Matched Case-Control Study

Abstract

BackgroundSurgical decompression is the recommended treatment for patients with non-functioning pituitary macroadenomas (NFPMAs) with associated visual impairment. Other relative indications for surgery include endocrinopathies, craniopathies, and headaches. Nevertheless, patients without those 'classical indications' who would otherwise be considered asymptomatic with regards to the NFPMAs, and treated conservatively with clinical radiological surveillance, may suffer higher rates of other morbidities related to the NFPMAs. We aimed to evaluate the prevalence of newly diagnosed comorbidities in conservatively treated patients with NFPMAs. MethodsWe reviewed the medical records of 55 patients with NFPMAs from 2012-2022 who lacked classical indications for surgery at diagnosis. During the follow-up period we searched for any of the following potentially associated newly reported symptoms and signs: headache, dizziness, syncope, GI symptoms, hyponatremia, falls, weakness and general deterioration, CVA related, and endocrine-related including DM-2. Patients were compared to a matched control group. Cohort patients were further analyzed to discover specific endocrine axes deficiencies, and tumor volumes were measured using MRI scans at diagnosis. Results55 patients were included in the final cohort. NFPMAs were associated with the development of newly diagnosed headaches, hypertension and Hypopituitarism. Other symptoms associated with NFPMAs included – dizziness, syncope/pre-syncope, GI-related symptoms, hyponatremia, general weakness and falls, infectious-related symptoms. Average associated ER visits in this group were higher compared to the control group. ConclusionsThese results may suggest the advantages of early surgical intervention for NFPMAs to mitigate comorbidities and improve health-related quality of life.