Non-functioning (NF) accidentally detected PitNETs (PIs) are common findings of CT/MRI scans currently. Data concerning their behavior vary, and some PIs will potentially experience a size change over time that might become clinically relevant. Objective: We aimed to evaluate CT-related PIs diameters following 3 aspects: a cross-sectional analysis based on the age’ groups at first PI diagnosis and on the gender distribution and a longitudinal analysis in PIs with <0.5 cm versus ≥0.5 cm as the largest diameter at baseline. Methods: A retrospective, real-life, multi-centric study in adults with NF micro-PIs was performed. Results: 208 subjects (92.79% females) were included (average age 43.18 ± 12.58 y). The mean largest diameter (between transversal and longitudinal diameters) was 0.55 ± 0.16cm, and 44.71% of the PIs were located on the right part of the pituitary gland. The patients were divided into 10 age-groups (21 to 70 y), and no difference was observed between the mean largest diameters of these groups (p= 0.693). Females and males had a similar age at PIs diagnosis (p= 0.353), transverse diameter (p= 0.910), longitudinal diameter (p= 0.229), and PI location (p= 0.368). Serial CT scans (2 to 4 per patient) included a median (Q1–Q3) of 20 (12–36) months for the second CT scan, 58 (36–84) for the third CT scan, 78 (53–118) for the fourth CT scan, and a total follow-up between baseline and last CT scan of 40 (13–72) months. The initial largest diameter correlated with the diameter change between the baseline and the last CT (r = −0.575,p= 0.000). The largest PI diameter was similar between each serial CT scan (p= 0.840). According to the cut-off value of 0.5 cm diameter (for initial largest tumor diameter), group A (N = 78, 37.50%, <0.5 cm) and group B (N = 130, 62. 50%; ≥0.5 cm) had similar age at baseline (43.83 ± 12.72 versus 42.79 ± 12.54 y,p= 0.565) and PIs locations (right, left, median). The largest PI diameter remained smaller in group A versus B amid the second CT scan (p= 0.000) and the last CT scan (p= 0.009). The largest diameter change from the first to the last CT scan showed an increase in group A (median of +0.10 cm,p= 0.000) and a decrease in group B (median of −0.01 cm,p= 0.002); this diameter change was different in group A versus B (p= 0.000). The cumulative probability of tumor-growth-free survival showed different survival functions (log rankp= 0.000): group A exhibited a more gradual decrease versus B; at 60 months, the cumulative probability was 0.32 ± 0.08 for group A versus 0.75 ± 0.07 for B. During follow-up, all PIs remained NF, and no hypopituitarism was noted (as limits, we mention that dynamic hypopituitarism testing was selectively performed). Conclusions: NF micro-PIs in adults showed a similar age and sex distribution. During follow-up, PIs with a largest diameter < 0.5 cm increased after a median of 40 months but remained <1 cm, while in PIs with ≥0.5 cm, the largest diameter decreased. This highlights a lower predictability in tumor behavior than expected, particularly in larger micro-PIs that, overall, remained without relevant clinical implications after surveillance.
无功能垂体神经内分泌肿瘤（PitNETs）目前是CT/MRI检查中常见的偶发发现。关于其生物学行为的数据存在差异，部分肿瘤可能随时间发生大小变化，并可能产生临床意义。目的：本研究旨在从三个维度评估CT检出的PitNETs直径特征：基于初诊年龄分组的横断面分析、基于性别分布的横断面分析，以及以基线最大直径＜0.5 cm与≥0.5 cm为分组的纵向分析。方法：开展一项多中心、回顾性、真实世界研究，纳入成人无功能性微PitNETs患者。结果：共纳入208例患者（女性占92.79%），平均年龄43.18±12.58岁。肿瘤最大直径（取横径与纵径较大值）均值为0.55±0.16 cm，44.71%位于垂体右侧。将患者按年龄分为10组（21-70岁），各组间最大直径均值无统计学差异（p=0.693）。不同性别患者在确诊年龄（p=0.353）、肿瘤横径（p=0.910）、纵径（p=0.229）及肿瘤位置（p=0.368）方面均无显著差异。系列CT扫描（每例患者2-4次）显示：第二次CT中位间隔时间为20（12-36）个月，第三次为58（36-84）个月，第四次为78（53-118）个月，基线至末次CT总随访期为40（13-72）个月。初始最大直径与基线至末次CT的直径变化呈负相关（r=-0.575, p=0.000）。各次CT扫描间最大直径保持稳定（p=0.840）。按0.5 cm临界值分组：A组（N=78，37.50%，＜0.5 cm）与B组（N=130，62.50%，≥0.5 cm）基线年龄（43.83±12.72岁 vs 42.79±12.54岁，p=0.565）及肿瘤位置分布无差异。在第二次CT（p=0.000）和末次CT（p=0.009）中，A组最大直径持续小于B组。从首次至末次CT的直径变化显示：A组呈增长趋势（中位值+0.10 cm，p=0.000），B组呈减小趋势（中位值-0.01 cm，p=0.002），两组间变化幅度差异显著（p=0.000）。肿瘤无进展生存累积概率曲线显示组间生存函数差异（log rank p=0.000）：A组下降较B组更为平缓；至60个月时，A组累积概率为0.32±0.08，B组为0.75±0.07。随访期间所有肿瘤均保持无功能性，未出现垂体功能减退（需说明的是，动态垂体功能检测为选择性实施）。结论：成人无功能性微PitNETs在年龄与性别分布上具有同质性。随访期间，最大直径＜0.5 cm的肿瘤在中位40个月后出现增大但仍维持＜1 cm，而≥0.5 cm的肿瘤最大直径反而减小。这提示肿瘤行为的可预测性低于预期，特别是较大微腺瘤在监测期间整体未产生显著临床影响。
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