SAT-103 Clinical Decision Making in Non-Functioning Pituitary Adenoma (NFPA): An Australian and New Zealand (ANZ) Survey-Based Study

Abstract Disclosure: E. Mignone: None. F. Saran: None. A. Psaltis: None. A. Jukes: None. R. Paul: None. R.W. Carroll: None. I. Chapman: None. D.J. Torpy: None. S.M. De Sousa: None. Background: There is, anecdotally, significant variability in the investigation and management of NFPA, likely attributable to a lack of contemporary guidelines specific to NFPA despite it being the most common subtype of pituitary adenoma. The aim of this survey-based study was to delineate current practices in NFPA across ANZ to guide future clinical and research initiatives. Methods: With approval by the Central Adelaide Local Health Network Human Research Ethics Committee, an anonymous online survey of 4 clinical scenarios and 23 questions was disseminated to ANZ consultant endocrinologists via the Endocrine Society of Australia and New Zealand Society of Endocrinology. Findings: A total of 75 endocrinologists completed the survey across Australia (88%) and New Zealand (12%), 21% of whom regularly attend pituitary multidisciplinary team (MDT) meetings, work in pituitary MDT clinics and see ≥5 pituitary cases monthly - classified as pituitary subspecialists for the purpose of this study. When investigating an incidental intrasellar pituitary microadenoma, >90% of respondents completed pituitary hormonal assessment with cortisol, IGF-1, prolactin, TSH, free T4, LH, FSH, and androgen studies for males. Heterogeneity was present in testing for GH (requested by 19% of pituitary subspecialists vs. 62% of general endocrinologists, p=0.0038) and ACTH (requested by 50% of pituitary subspecialists vs. 77% of general endocrinologists, p=0.06). Noting normal visual fields on confrontation in the scenario, 76% of respondents did not request formal visual field testing and 73% repeated the MRI at 12 months, without apparent effect by subspecialist status. Gadolinium was requested on repeat MRI in 81% of pituitary subspecialists vs. 65% of general endocrinologists (p=0.36). In managing a macroadenoma complicated by visual field deficit, the vast majority of respondents referred the patient for trans-sphenoidal surgery, with 63% of pituitary subspecialists also arranging MDT meeting case review vs. 40% of general endocrinologists (p=0.16). 94% of pituitary subspecialists stated the case load of the receiving neurosurgeon to be ≥20 pituitary operations per year vs. 48% of general endocrinologists (p=0.001) When residual cavernous sinus disease was evident postoperatively, all pituitary subspecialists proceeded with monitoring alone, while 8% of general endocrinologists proceeded with intervention (referral to neurosurgery or radiation oncology). Conclusions: Significant variability exists in the investigation and management of NFPAs by endocrinologists across ANZ, likely reflective of international practice, with apparent disparity based on subspecialist status. Our findings support the need for NFPA studies and ultimately guidelines focusing on areas of contention e.g., the specifics of hormone testing and the value of MDT meeting case review. Presentation: Saturday, July 12, 2025