23rd May 2025

Non-Functioning Pituitary Adenomas

Pituitary adenomas may be functioning, leading to diseases outlined above, or non-functioning (NFPA). NFPA are classified as microadenomas (<1cm diameter) or macroadenomas (>1cm diameter). 

Patients will often present with headache and visual symptoms, such as superior temporal quadrantanopia or temporal hemianopsia, due to mass effect of the tumour. NFPAs can also be detected as an incidental finding on imaging. 

To investigate, a panel of serum pituitary hormone levels are taken alongside routine bloods such as FBC and U&Es. Neuroimaging, such as MRI pituitary with contrast, can also be considered.

Management

• Microadenoma and patient asymptomatic: Observation
• Macroadenoma with no mass effect and not compressing optic chiasm: Observation. Can consider hormone replacement therapy if needed.
• Macroadenoma with mass effect and/or compressing optic chiasm: Transsphenoidal surgery to resect tumour. Then hormone replacement therapy. If these strategies fail, radiotherapy, dopamine agonists or somatostatin analogues may be tried

Image Source: Wikimedia Commons (2020). Hemianopsia, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Hemianopsia_en.jpg (Accessed 13 May 2025).