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

Authors

Camilla Jerning, Charlotte Höybye, Sophie Bensing, Britt Edén Engström, Nasrin Al-Shamkhi, Bertil Ekman, Lorenza Bonelli, Henrik Borg, Pia Burman, Per Dahlqvist, Victor Hantelius, Oskar Ragnarsson, Anna Svensson, Jeanette Wahlberg, Anna-Karin Åkerman, Katarina Berinder, Maria Petersson

Published in

Pituitary. Volume 29. Issue 5. Aug 20, 2026. Epub Aug 20, 2026.

Abstract

To investigate adenoma progression, pituitary function, visual impairment, and need for later surgery in elderly patients with conservatively managed nonfunctioning pituitary macroadenomas (macro-NFPAs).
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.
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.
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.

PMID:
42622973
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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