Cohort overview

The specific patient and tumor attributes are detailed in Table 1. A Cohort of 357 patients harboring NFA’s was analyzed. SCAs formed 14% (n = 50), and the control-NFA’s group formed 86% (n = 307). Males formed 49.7% (n = 156), not significantly different between the groups (p = 0.173). The median age was 55.2 years (range 13.7–87), and the mean age was 50.9 ± 13 years, not significantly different between the groups (p = 0.06). Before SRS, all patients underwent at least one trans-sphenoidal tumor resection (TSR, range 1–3). Patients received a neuro-ophthalmologic evaluation and comprehensive endocrine studies, which included serum cortisol, ACTH, free thyroxine, thyroid-stimulating hormone (TSH), insulin-like growth factor 1 (IGF-1), GH, and testosterone (men) immediately before SRS. Pre-SRS visual deficit was comparable between the groups (44%, n = 22 in the SCAs versus 48.5%, n = 149 in the control NFA’s respectively, p = 0.658), as were the weakness or fatigue (p = 0.71) and sexual dysfunction (p = 0.796). Pre-SRS headaches were reported significantly more in the SCA group (72.9% (n = 35) in the SCAs versus 6.1% (n = 14) in the control NFA’s respectively, p < 0.0001).

Patient and tumor related parameters, compared

Statistically significant values are in bold

SCA silent ACTH staining pituitary adenoma, NFA’s non-functioning pituitary adenomas, ACTH adrenocorticotrophic hormone, TSR trans-sphenoidal resection, SRS stereotactic radiosurgery, mm millimeter, Gy gray, TV tumor volume

The different tumor features were also comparable between the groups, including the median and mean maximal tumor diameter (3 and 3.3 cm in the SCAs versus 2.9 and 3.1 cm in the control NFA’s respectively, p = 0.359), median and mean tumor volume [4.3 cm³ (0.2–27) and 5.6 cm³ (±6.9) in the SCAs versus 3.8 cm³ (0.1–57.3) and 5.52 cm³ (±6) in the control NFA’s respectively, p = 0.951], cavernous sinus invasion [77.3% (n = 38) in the SCAs versus 70.9% (n = 210) in the control NFA’s respectively, p = 0.434], and suprasellar extension [75.5% (n = 37) in the SCAs versus 84.8% (n = 251) in the control NFA’s respectively, p = 0.157].

Pre-SRS pituitary endocrine deficiency involving any axis was noted significantly more common in the control NFA’s group [55.4% (n = 170)] than in the SCAs [34% (n = 17)] (p = 0.008). Specifically, hypogonadism was noted in 18% (n = 9) of SCAs and 30.6% (n = 94) of control-NFA’s group (p = 0.0973), hypo-ACTH was noted in 16% (n = 8) of SCAs and 26.7% (n = 82) of control-NFA’s group (p = 0.0149) and hypothyroidism was noted in 18% (n = 9) of SCAs and 37.1% (n = 114) of control-NFA’s group (p = 0.013). Pan-hypopituitarism prior to SRS was noted in 12% (n = 6) of SCAs and 20.2% (n = 62) of control-NFA’s group (p = 0.024).