Conservatively managed non-functioning pituitary macroadenomas - Cohort study from the UK Non-functioning Pituitary Adenoma Consortium

\ua9 2025 The Author(s). Published by Oxford University Press on behalf of European Society of Endocrinology.Objective: Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium. Design: This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments. Methods: Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed. Results: Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%). Conclusions: Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment

Conservatively managed non-functioning pituitary macroadenomas – cohort study from the UK Non-functioning Pituitary Adenoma Consortium

Objective Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium. Design This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments. Methods Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed. Results Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%). Conclusions Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment

Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium

Objective The optimal approach to the surveillance of non-functioning pituitary microadenomas (micro-NFPAs) is not clearly established. Our aim was to generate evidence on the natural history of micro-NFPAs to support patient care. Design Multi-centre, retrospective, cohort study involving 23 endocrine departments (UK NFPA consortium). Methods Clinical, imaging, and hormonal data of micro-NFPA cases between January, 1, 2008 and December, 21, 2021 were analysed. Results Data for 459 patients were retrieved [median age at detection 44 years (IQR 31-57)—152 males/307 females]. Four hundred and nineteen patients had more than two magnetic resonance imagings (MRIs) [median imaging monitoring 3.5 years (IQR 1.71-6.1)]. One case developed apoplexy. Cumulative probability of micro-NFPA growth was 7.8% (95% CI, 4.9%-8.1%) and 14.5% (95% CI, 10.2%-18.8%) at 3 and 5 years, respectively, and of reduction 14.1% (95% CI, 10.4%-17.8%) and 21.3% (95% CI, 16.4%-26.2%) at 3 and 5 years, respectively. Median tumour enlargement was 2 mm (IQR 1-3) and 49% of micro-NFPAs that grew became macroadenomas (nearly all >5 mm at detection). Eight (1.9%) patients received surgery (only one had visual compromise with surgery required >3 years after micro-NFPA detection). Sex, age, and size at baseline were not predictors of enlargement/reduction. At the time of detection, 7.2%, 1.7%, and 1.5% patients had secondary hypogonadism, hypothyroidism, and hypoadrenalism, respectively. Two (0.6%) developed hypopituitarism during follow-up (after progression to macroadenoma). Conclusions Probability of micro-NFPA growth is low, and the development of new hypopituitarism is rare. Delaying the first follow-up MRI to 3 years and avoiding hormonal re-evaluation in the absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance

Is there a change in P wave parameters following pulmonary vein isolation (PVI) using radiofrequency ablation (RF) vs. cryoballoon ablation (CRYO) for paroxysmal atrial fibrillation (PAF)?

Abstract Funding Acknowledgements Type of funding sources: None. Pulmonary vein isolation (PVI) is an effective and established therapy for paroxysmal atrial fibrillation (PAF) . PVI can be performed using point by point ablation with radiofrequency (RF) or with single shot techniques such as cryoballoon (CRYO). As P waves represent atrial depolarization, we aimed to study whether P wave metrics may change after PVI and if there are differences between RF and CRYO approaches. Methods We studied 88 matched patients who had PVI for PAF between January 2017 and December 2018 (RF = 44, CRYO = 44). Each patient was in sinus rhythm (SR) prior to ablation. Patients on amiodarone and those who had additional linear ablation were excluded. Patients had continuous ECG monitoring using Labsystem Pro (Boston Scientific Inc). Sampled at 1kHz during the procedure. One-minute recordings before and after PVI were exported and analysed using custom-written software using MatLab (v2018, bandpass 1-50Hz) to annotate P wave onset, peak and end. P wave duration was heart rate corrected (PWDc) by using the Hodges formula and P wave amplitude (PWA). Results P wave metrics were comparable before PVI between both cohorts. Successful PVI was achieved in all patients. There was a trend towards an increase in PWDc in some ECG leads with either RF or CRYO but no significant difference in P wave metrics as a result of PVI ablation or between both ablation modalities. Conclusion In this study, there was no significant change seen in PVI with RF or CRYO and no difference between the 2 ablation modalities. P wave metrics comparison, RF vs CRYO PWDc (ms) PRE, RF (n = 44) POST, RF (n = 44) P PRE, CRYO (n = 44) POST CRYO (n = 44) P P (RF vs CRYO) I 134.7 ± 32 133.5 ± 35 0.813 131.9 ± 36 132.7 ± 39 0.9 0.81 II 140.9 ± 34 144.1 ± 37 0.56 139.4 ± 42 134.4 ± 40 0.51 0.41 III 131.5 ± 31 143.3 ± 37 0.04 132.8 ± 41 130.6 ± 36 0.68 0.074 AVF 137 ± 32 144.7 ± 36 0.15 137.5 ± 42 127.4 ± 37 0.11 0.141 V1 143.9 ± 33 151.8 ± 37 0.17 133.6 ± 37 143.8 ± 38 0.09 0.745 PWA (mV) PRE, RF (n = 44) POST, RF (n = 44) P PRE, CRYO (n = 44) POST CRYO (n = 44) P P (RF vs CRYO) I 0.125 ± 0.08 0.09 ± 0.06 0.002 0.13 ± 0.08 0.14 ± 0.09 0.59 0.076 II 0.238 ± 0.1 0.238 ± 0.1 0.98 0.232 ± 0.1 0.278 ± 0.2 0.1 0.212 III 0.149 ± 0.1 0.153 ± 0.1 0.83 0.189 ± 0.1 0.187 ± 0.1 0.97 0.86 AVF 0.195 ± 0.1 0.196 ± 0.1 0.92 0.197 ± 0.1 0.247 ± 0.1 0.066 0.132 V1 0.122 ± 0.1 0.151± 0.1 0.05 0.138 ± 0.1 0.193 ± 0.2 0.002 0.543 PWDc and PWA comparison following RF vs CRYO. </jats:sec

Pulmonary veins reconnection pattern differences after failed radiofrequency ablation and cryoballoon ablation for atrial fibrillation

Abstract   Point-by-point radiofrequency ablation (RF) and one-shot cryoballoon ablation (CRYO) electrically isolate pulmonary veins (PVs) in atrial fibrillation (AF) using different techniques and energies. This study aimed to examine differences in PVs reconnection pattern and ablation lesions required to re-isolate PVs after failed RF and failed CRYO. Methods Twenty-four patients who had their repeat ablation between January 2017-December 2020 were studied with six months of learning curve for CRYO. Fourteen patients had paroxysmal atrial fibrillation (PAF). Failed first ablations were defined by electrocardiogram (ECG) documented AF within twelve months following three months blanking period. Repeat ablations were performed using CARTO3® mapping system, which was utilized to locate ablation lesions and impedance drop details. Results 2,260 lesions were collected from 63 reconnected PVs (31 isolated after RF vs 32 isolated veins after CRYO). 849 lesions were targeted towards triggers. Repeat ablation procedure time was similar between both cohorts. However, repeat ablation after failed CRYO had longer fluoroscopy time (19.8±2 vs 12.4±2.1 minutes, P=0.019). The right lower pulmonary vein (RLPV) was reconnected after failed CRYO for AF in 92% of patients and 100% in PAF patients. Although PV reconnection pattern was similar between both cohorts, RLPV and left upper pulmonary vein (LUPV) required more ablation lesions after failed CRYO. Left lower pulmonary vein (LLPV) and right upper pulmonary vein (RUPV) required more ablation lesions after failed RF. Impedance drop was similar in both cohorts. Conclusion After failed CRYO for PAF, RLPV was reconnected in all patients. RUPV and LLPV required more ablation lesions after failed RF, while RLPV and LLPV required more ablation lesions after failed CRYO. Funding Acknowledgement Type of funding sources: None. PVs reconnection patternLesions number and percentage comparison </jats:sec