Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Natural history of conservatively managed nonfunctioning pituitary macroadenomas in the elderly : A study from the Swedish Pituitary Registry

Jerning, Camilla ; Höybye, Charlotte ; Bensing, Sophie ; Engström, Britt Edén ; Al-Shamkhi, Nasrin ; Ekman, Bertil ; Bonelli, Lorenza ; Borg, Henrik LU ; Burman, Pia LU and Dahlqvist, Per , et al. (2026) In Pituitary 29(5).
Abstract

Purpose: To investigate adenoma progression, pituitary function, visual impairment, and need for later surgery in elderly patients with conservatively managed nonfunctioning pituitary macroadenomas (macro-NFPAs). Methods: Patients ≥ 65 years in the Swedish Pituitary Registry diagnosed 1991–2023 with macro-NFPA and a decision for conservative management were included (n = 673, 38% females). Data at diagnosis and at 1- and 5-year follow-up, defined as assessments closest to 1 year (0.5–<2.5) and 5 years (2.5–<7.5), were retrieved. Surgery was recorded up to 7.5 years. Variables included adenoma size, pituitary function, visual impairment, and surgery. Patients were stratified into age groups 65–72, 73–80, and ≥ 81 years. Results: At... (More)

Purpose: To investigate adenoma progression, pituitary function, visual impairment, and need for later surgery in elderly patients with conservatively managed nonfunctioning pituitary macroadenomas (macro-NFPAs). Methods: Patients ≥ 65 years in the Swedish Pituitary Registry diagnosed 1991–2023 with macro-NFPA and a decision for conservative management were included (n = 673, 38% females). Data at diagnosis and at 1- and 5-year follow-up, defined as assessments closest to 1 year (0.5–<2.5) and 5 years (2.5–<7.5), were retrieved. Surgery was recorded up to 7.5 years. Variables included adenoma size, pituitary function, visual impairment, and surgery. Patients were stratified into age groups 65–72, 73–80, and ≥ 81 years. Results: At diagnosis, mean age was 76 years, females were older (p < 0.001). Mean adenoma diameter and volume were 20 mm and 3067 mm³. Visual field defects and reduced visual acuity were seen in 20% and 12%, with no sex differences. Males had more hormone deficiencies (45% vs. 33%, p < 0.01). Hormone deficiencies and visual impairments increased with age (p < 0.001). The oldest subgroup had the largest adenomas (p < 0.01), with females having larger tumours (p < 0.05) and males more deficiencies (p < 0.05). Adenoma size, hormone deficiencies, and visual impairments remained stable over time within each age group. 6.7% underwent surgery during follow-up. In regression analyses, later surgery was associated with visual field defects at diagnosis (p < 0.05) but not with adenoma size. Conclusion: Pituitary surgery was uncommon in conservatively managed elderly patients with macro-NFPAs. Baseline visual field defects, but not tumour size, were associated with subsequent surgery, supporting regular individualised follow-up in these patients.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adenoma size, Conservative management, Elderly patients, Hypopituitarism, Nonfunctioning pituitary macroadenoma, Visual impairment
in
Pituitary
volume
29
issue
5
article number
147
publisher
Springer
external identifiers
  • pmid:42622973
  • scopus:105047773511
ISSN
1386-341X
DOI
10.1007/s11102-026-01752-z
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2026.
id
396d0a60-6c44-4bd2-b94d-509f9a74e9b2
date added to LUP
2026-10-01 16:05:57
date last changed
2026-10-02 03:00:03
@article{396d0a60-6c44-4bd2-b94d-509f9a74e9b2,
  abstract     = {{<p>Purpose: To investigate adenoma progression, pituitary function, visual impairment, and need for later surgery in elderly patients with conservatively managed nonfunctioning pituitary macroadenomas (macro-NFPAs). Methods: Patients ≥ 65 years in the Swedish Pituitary Registry diagnosed 1991–2023 with macro-NFPA and a decision for conservative management were included (n = 673, 38% females). Data at diagnosis and at 1- and 5-year follow-up, defined as assessments closest to 1 year (0.5–&lt;2.5) and 5 years (2.5–&lt;7.5), were retrieved. Surgery was recorded up to 7.5 years. Variables included adenoma size, pituitary function, visual impairment, and surgery. Patients were stratified into age groups 65–72, 73–80, and ≥ 81 years. Results: At diagnosis, mean age was 76 years, females were older (p &lt; 0.001). Mean adenoma diameter and volume were 20 mm and 3067 mm³. Visual field defects and reduced visual acuity were seen in 20% and 12%, with no sex differences. Males had more hormone deficiencies (45% vs. 33%, p &lt; 0.01). Hormone deficiencies and visual impairments increased with age (p &lt; 0.001). The oldest subgroup had the largest adenomas (p &lt; 0.01), with females having larger tumours (p &lt; 0.05) and males more deficiencies (p &lt; 0.05). Adenoma size, hormone deficiencies, and visual impairments remained stable over time within each age group. 6.7% underwent surgery during follow-up. In regression analyses, later surgery was associated with visual field defects at diagnosis (p &lt; 0.05) but not with adenoma size. Conclusion: Pituitary surgery was uncommon in conservatively managed elderly patients with macro-NFPAs. Baseline visual field defects, but not tumour size, were associated with subsequent surgery, supporting regular individualised follow-up in these patients.</p>}},
  author       = {{Jerning, Camilla and Höybye, Charlotte and Bensing, Sophie and Engström, Britt Edén and Al-Shamkhi, Nasrin and Ekman, Bertil and Bonelli, Lorenza and Borg, Henrik and Burman, Pia and Dahlqvist, Per and Hantelius, Victor and Ragnarsson, Oskar and Svensson, Anna and Wahlberg, Jeanette and Åkerman, Anna Karin and Berinder, Katarina and Petersson, Maria}},
  issn         = {{1386-341X}},
  keywords     = {{Adenoma size; Conservative management; Elderly patients; Hypopituitarism; Nonfunctioning pituitary macroadenoma; Visual impairment}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Springer}},
  series       = {{Pituitary}},
  title        = {{Natural history of conservatively managed nonfunctioning pituitary macroadenomas in the elderly : A study from the Swedish Pituitary Registry}},
  url          = {{http://dx.doi.org/10.1007/s11102-026-01752-z}},
  doi          = {{10.1007/s11102-026-01752-z}},
  volume       = {{29}},
  year         = {{2026}},
}