Oral Presentation Australian and New Zealand Pituitary Alliance 2025

2025 ANZ interdisciplinary survey of non-functioning pituitary adenoma management: areas of variability and common practice (123502)

Edward Mignone 1 2 , Frank Saran 2 3 , Alkis Psaltis 2 4 , Alistair Jukes 2 5 , Ryan Paul 6 , Richard Carroll 7 , Ian Chapman 2 8 , David Torpy 2 8 , Sunita De Sousa 2 8
  1. Endocrinology, Flinders Medical Centre, Adelaide, South Australia
  2. University of Adelaide, Adelaide, South Australia
  3. Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia
  4. Otolaryngology, Queen Elizabeth Hospital, Adelaide, South Australia
  5. Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia
  6. Endocrinology, Waikato Hospital, Waikato, New Zealand
  7. Endocrinology, Capital and Coast District Health Board, Wellington, New Zealand
  8. Endocrinology, Royal Adelaide Hospital, Adelaide, South Australia

Background:

There is, anecdotally, variability in the investigation and management of non-functioning pituitary adenomas (NFPA), reflecting a lack of contemporary guidelines specific to NFPA. A multidisciplinary team of clinicians with experience in pituitary tumours designed a questionnaire to determine currents practices in NFPA in Australia and New Zealand (ANZ) and guide future initiatives.

Methods:

Approved by the Central Adelaide Local Health Network Human Research Ethics Committee, an anonymous online survey comprising four clinical scenarios with 23 questions was disseminated to ANZ consultant endocrinologists, neurosurgeons and rhinologists via their respective professional societies.  

Findings:

Respondents comprised 99 endocrinologists, 11 neurosurgeons and 14 rhinologists. In relation to microadenomas, gadolinium enhancement was variably requested for MRI assessment of a microadenoma. Variation existed amongst surgeons, but over 80% of endocrinologists measured cortisol, FSH, LH, androgens (for males), TSH, FT4, prolactin and IGF-1 at baseline, and repeated a pituitary MRI after 12 months. more variability was present amongst surgeons. There was less conformity regarding endocrine follow-up timing. The management of macroadenomas without suprasellar extension was variable: 40% and 16% arranged next review at 6 and 12 months respectively; 38% requested visual fields despite a lack of chiasmal involvement; and 6% referred directly for surgery. Timing of postoperative serum cortisol measurement, visual field assessment and neuroimaging was heterogeneous. While most respondents recommended active surveillance of residual cavernous sinus disease (86%), there was little consensus regarding growth thresholds triggering intervention. Practice differences were observed between endocrinologists with more vs. less pituitary exposure and between endocrinologists vs. surgeons.

Conclusions:

This contemporary large survey dataset (n=124) highlights areas of common practice but also several discrepancies in the care of patients with NFPA, serving as a roadmap for further research to clarify optimal practices and potential barriers (e.g., resourcing, accessibility) and to ultimately inform guideline recommendations.