Endocrinology

Your Guide to Non-functioning Pituitary Adenoma (NFPA)

At a Glance

A non-functioning pituitary adenoma (NFPA) is a benign, slow-growing tumor of the pituitary gland that does not produce extra hormones. While not cancerous, it can cause headaches, vision loss, and hormone deficiencies. Treatment ranges from watchful waiting to surgery depending on its size.

Receiving a diagnosis of a non-functioning pituitary adenoma (NFPA) can feel like a contradiction. You have been told you have a brain tumor, yet it is called “non-functioning.” For many, this diagnosis comes after a long search for answers to vague symptoms like headaches or fatigue; for others, it is a complete shock found during a scan for something else entirely ^[1]^[2].

The most important thing to know right now is that an NFPA is almost always benign, meaning it is not a fast-spreading cancer ^[3]^[4]. While the word “tumor” is frightening, this condition is manageable, and many people live full, healthy lives after diagnosis.

Navigating Your Diagnosis

This guide is designed to empower you with evidence-based information to help you understand your diagnosis, build the right medical team, and prepare for treatment.

Symptoms & Warning Signs: Does This Explain What I'm Feeling?

Learn about non-functioning pituitary adenoma (NFPA) symptoms. Understand how tumor size, mass effect, and hormone deficiencies cause vision loss and fatigue.

The Diagnostic Process: Mapping Your NFPA

Learn how non-functioning pituitary adenomas (NFPAs) are diagnosed. Understand the role of MRI scans, the five hormone axes, and vision tests like OCT.

Biology & Pathology: Auditing Your Pathology Report

Learn how to read your pituitary adenoma (PitNET) pathology report. Understand the 2022 WHO updates, transcription factors, Ki-67 index, and tumor lineage.

Standard of Care: Surgery, Radiation, and Observation

Learn about standard treatments for non-functioning pituitary adenomas (NFPA), including watchful waiting, endoscopic transsphenoidal surgery, and radiation.

Building Your Care Team & First Visit Prep

Learn how to build a multidisciplinary care team for your non-functioning pituitary adenoma (NFPA) and exactly what to bring to your first specialist visit.

Survivorship & Long-Term Monitoring: Life After Diagnosis

Learn about life after a non-functioning pituitary adenoma (NFPA). Understand long-term MRI scan schedules, recurrence risks, and hormone management.

Three Stabilizing Facts

When you are in a “panic spiral,” these three research-backed facts can help ground you:

It is Not Brain Cancer: NFPAs are typically slow-growing, benign tumors ^[3]. They do not spread to other parts of the body like malignant cancers do ^[4].
It is Common (Among Specialists): While you may have never heard of it, NFPAs make up about one-third of all pituitary tumors ^[3]. While a general practitioner may only see a few in their career, a neuroendocrinologist (a specialist in hormone-producing glands) treats them every day ^[5].
Treatment is Often Highly Effective: If the tumor is small and not causing symptoms, your doctor may suggest “watchful waiting” ^[1]. If it needs to be removed, modern surgical techniques frequently lead to significant improvements in vision and quality of life ^[6]^[7].

Understanding the Rarity and Impact

The incidence rate of NFPA is approximately 3.5 cases per 100,000 people annually ^[8]. Because it is a specialized condition, your local doctor may have limited experience. This is why many patients seek care at “Centers of Excellence” where teams of specialists work together.

How the Condition Works

NFPAs usually follow one of two paths:

The “Mass Effect”: As the tumor grows, it can press on the optic chiasm (the nerves that connect your eyes to your brain), leading to vision loss, particularly in your side (peripheral) vision ^[9]^[10]. It can also cause persistent headaches ^[2].
Hormone Deficiency: By pressing on the healthy pituitary tissue, the tumor can cause hypopituitarism, where your body doesn’t make enough of certain hormones ^[11]. This can lead to Growth Hormone Deficiency (causing fatigue), secondary hypothyroidism, or other hormonal imbalances ^[12]^[13].

Common questions in this guide

Is a non-functioning pituitary adenoma a type of brain cancer?

No, an NFPA is almost always a benign, slow-growing tumor. It does not spread to other parts of the body like malignant cancers do, and many patients live full, healthy lives after diagnosis.

What symptoms do non-functioning pituitary adenomas cause?

As the tumor grows, it can press on the optic nerves, causing peripheral vision loss or persistent headaches. It can also compress the healthy pituitary gland, leading to hormone deficiencies that cause fatigue and other imbalances.

What are the standard treatment options for an NFPA?

Treatment depends on the size of the tumor and the symptoms it causes. Options range from 'watchful waiting' for small, asymptomatic tumors to specialized surgery through the nose to remove the mass and relieve pressure on the brain.

What kind of doctor should I see for a pituitary adenoma?

Because NFPAs are a specialized condition, it is highly recommended to see a neuroendocrinologist or a neurosurgeon who specializes in pituitary tumors. Seeking care at a center of excellence ensures you have a team experienced in managing this specific condition.

Curated prompts to bring to your next appointment.

1.What is the exact size of my tumor, and is it touching or pressing on my optic nerves?
2.Based on my blood work, which of my hormone levels are currently affected, and which are normal?
3.Does this clinic specialize in pituitary tumors? How many non-functioning adenomas do you treat each year?
4.Is my tumor a microadenoma or a macroadenoma, and how does that change the 'wait and watch' versus surgery decision?
5.If we choose to monitor the tumor, what specific symptoms should I look for that would mean we need to change the plan?
6.What are the chances of this tumor growing back after treatment, and how will we monitor for that?

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References (13)

1
Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas.
Iglesias P, Arcano K, Triviño V, et al.
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2017; (49(9)):654-659 doi:10.1055/s-0043-115645.
PMID: 28759937
2
Clinical characteristics and risk factors for headache associated with non-functioning pituitary adenomas.
Yu B, Ji N, Ma Y, et al.
Cephalalgia : an international journal of headache 2017; (37(4)):348-355 doi:10.1177/0333102416648347.
PMID: 27154998
3
Identification of a multidimensional transcriptome signature predicting tumor regrowth of clinically non‑functioning pituitary adenoma.
Cheng S, Guo J, Zhang Y, et al.
International journal of oncology 2020; (57(3)):804-812 doi:10.3892/ijo.2020.5087.
PMID: 32582995
4
Chromosomal and oxidative DNA damage in non-functioning pituitary adenomas.
Bitgen N, Bayram F, Hamurcu Z, et al.
Endokrynologia Polska 2021; (72(2)):97-103 doi:10.5603/EP.a2020.0084.
PMID: 33295635
5
A two‑circRNA signature predicts tumour recurrence in clinical non‑functioning pituitary adenoma.
Guo J, Wang Z, Miao Y, et al.
Oncology reports 2019; (41(1)):113-124 doi:10.3892/or.2018.6851.
PMID: 30542712
6
Headache in patients with non-functioning pituitary adenoma before and after transsphenoidal surgery - a prospective study.
Hantelius V, Ragnarsson O, Johannsson G, et al.
Pituitary 2024; (27(5)):635-643 doi:10.1007/s11102-024-01401-3.
PMID: 38767698
7
Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience.
Ferreli F, Turri-Zanoni M, Canevari FR, et al.
Rhinology 2015; (53(4)):308-16 doi:10.4193/Rhino14.309.
PMID: 26301431
8
Incidence, mortality, and cardiovascular diseases in pituitary adenoma in Korea: a nationwide population-based study.
Oh JS, Kim HJ, Hann HJ, et al.
Pituitary 2021; (24(1)):38-47 doi:10.1007/s11102-020-01084-6.
PMID: 32949324
9
A comparative study of functioning and non-functioning pituitary adenomas.
Qin J, Li K, Wang X, Bao Y
Medicine 2021; (100(14)):e25306 doi:10.1097/MD.0000000000025306.
PMID: 33832102
10
A Factorial Analysis on Visual Outcomes of Transsphenoidal Surgery for Pituitary Macroadenoma.
Ng BCF, Mak CH, Steffi CSY, et al.
Asian journal of neurosurgery 2022; (17(2)):280-285 doi:10.1055/s-0042-1751011.
PMID: 36120608
11
Clinical Concerns about Recurrence of Non-Functioning Pituitary Adenoma.
Lee MH, Lee JH, Seol HJ, et al.
Brain tumor research and treatment 2016; (4(1)):1-7 doi:10.14791/btrt.2016.4.1.1.
PMID: 27195254
12
Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients.
Mukai K, Kitamura T, Tamada D, et al.
Endocrine journal 2016; (63(11)):965-976 doi:10.1507/endocrj.EJ16-0168.
PMID: 27534814
13
Healthcare cost and survival in patients with non-functioning pituitary adenoma.
Olsson DS, Svensson M, Labori F, et al.
European journal of endocrinology 2023; (188(6)):477-484 doi:10.1093/ejendo/lvad057.
PMID: 37232269

This guide provides educational information about non-functioning pituitary adenomas and does not replace professional medical advice. Always consult your neuroendocrinologist or neurosurgeon for personalized treatment and monitoring plans.

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