Hypopituitarism tends to occur in large pituitary adenomas. However, similar tumors could present with strikingly different hormonal deficiencies. In this study, we looked at MRI characteristics in non-functioning pituitary adenomas (NFPA), which could predict secondary adrenal insufficiency (SAI) and central hypothyroidism (CHT). We reviewed the files of patients with NFPA attending our clinic. Tumor size, invasiveness, MR-signal intensity, and gadolinium enhancement in preoperative MRI were recorded along with documented presurgical hypopituitarism profile. Logistic regression was used to predict SAI, CHT or both (SAI/CHT) based on MRI and demographic parameters. Receiver operating characteristic curves were used to determine their diagnostic utility. 121 patients were included. Older age (P=0.021), male sex (P=0.043), stalk deviation (P<0.0001), contrast enhancement (P=0.029) and optic chiasma compression (P=0.012) were associated with SAI/CHT. Adenoma vertical height, largest diameter, and estimated volume were also strongly associated with SAI/CHT (P<0.0001). These associations remained significant in a multivariate analysis. No tumor smaller than 12mm in vertical height, 17mm in largest diameter, or 0.9 cm3 in volume was associated with SAI/CHT. At cutoff >18mm for vertical height, >23 mm for largest diameter, and >3.2 cm3 the sensitivity was around 90-92% for detecting SAI/CHT. Only vertical height was significantly associated with any one or more pituitary hormonal deficit (P=0.001). In conclusion, adenoma size, independent of the measurement used, remains the best predictor of SAI/CHT in NFPA. Dynamic testing to rule out SAI is probably indicated in adenomas larger than 18 mm vertical height, 23 mm largest diameter and 3.2cm3 adenoma volume.
Correction to: Solid tumor size for prediction of recurrence in large and giant non-functioning pituitary adenomas