Reassessing predictors of non-functioning pituitary macroadenoma growth: Beyond tumor volume.

Kim et al.'s study (Clinical Neurology and Neurosurgery, 2025;254:108920) investigates the natural history of 232 conservatively managed non-functioning pituitary macroadenomas (NFPMAs), identifying female sex and initial tumor volume (≥2.5 cm³) as predictors of growth. While offering valuable insights, the study's reliance on static tumor volume is questioned by recent evidence emphasizing dynamic features (e.g., growth velocity) and molecular markers (e.g., Ki-67, USP8 mutations) as stronger predictors. The reported 47.4 % growth rate may underestimate risks, with other studies noting higher progression (up to 60 %) and visual/hormonal deficits. Furthermore, dismissing age as a predictor contradicts findings linking younger age (<50 years) to increased progression risk. These limitations highlight the need for a more comprehensive approach to NFPMA risk stratification.