Highlights
- •Pituitary incidentalomas are lesions which are detected incidentally during imaging procedures for unrelated causes.
- •Micro-incidentalomas (less than 1 cm in size) have a reported mean prevalence in normal individuals of around 10%.
- •The endocrinologist facing a pituitary incidentaloma has to solve two main diagnostic problems: the nature and extent of the lesion, and the hormonal excess or deficits resulting from this lesion.
- •Visual deficits or neurological disturbances due to compression of the optic chiasm or nerve by the incidentaloma are the strongest recommendations for surgery.
- •Hormonally active incidentalomas, with the exception of prolactinomas, should be also treated by surgery.
Abstract
Pituitary incidentalomas are lesions which are detected incidentally in the pituitary
gland during imaging procedures for unrelated causes, such as headache, trauma or
symptoms involving the neck or central nervous system. The wide application of sensitive
brain imaging techniques (CT, MRI) has led to an increasing recognition of such lesions.
Although the etiology of pituitary incidentalomas covers a wide range of pathologies,
most of them (∼90%) are benign adenomas; nonetheless, they may result in visual and/or
neurologic abnormalities. By definition, micro-incidentalomas have maximum diameter
of less than 1 cm, while macro-incidentalomas are at least 1 cm. Micro-incidentalomas have a reported mean prevalence in normal individuals of
around 10%. The endocrinologist facing a pituitary incidentaloma has to solve two
main diagnostic problems: (i) the nature and extent of the lesion, and (ii) whether
hormonal excess or deficits result from the lesion. The former is achieved by the
use of pituitary MRI and visual field (VF) examination and the latter by basal or
dynamic hormonal assessments. The answers to these two questions will guide the treatment
and follow-up. VF deficits or neurological disturbances due to compression of the
optic chiasm or nerve by the incidentaloma are the strongest recommendations for surgery.
Furthermore, hormonally active incidentalomas, with the exception of prolactinomas,
should be treated by surgery. Most cases of pituitary incidentalomas do not meet criteria
for surgical excision, but may require follow-up. The follow-up strategy consists
of clinical evaluation, pituitary MRI, VF examination and hormonal assessments. Macro-incidentalomas
require more extensive initial investigation, as well as closer MRI surveillance,
than micro-incidentalomas. Diagnostic, treatment and follow-up strategies should be
in alignment with the optimal personalized clinical benefit.
Abbreviations:
α-SU (α-subunits), ACTH (adrenocorticotropic hormone), CN (cranial nerve), CT (computed tomography), FSH (follicle-stimulating hormone), Gd (gadolinium), GH (growth hormone), LH (luteinizing hormone), MRI (magnetic resonance imaging), PRL (prolactin), TSH (thyroid stimulating hormone), VF (visual field)Keywords
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References
- Pituitary tumours: pituitary incidentalomas.Best Pract. Res. Clin. Endocrinol. Metab. 2009; 23: 667-675
- Pituitary incidentalomas.Endoc. Abstr. 2012; 29: MTE25
- Pituitary incidentaloma: an endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab. 2011; 96: 894-904
- Endocrine incidentalomas–challenges imposed by incidentally discovered lesions.Nat. Rev. Endocrinol. 2011; 7: 668-680
- Nonfunctioning pituitary tumors and pituitary incidentalomas.Endocrinol. Metab. Clin. North Am. 2008; 37 (xi): 151-171
- Analysis and natural history of pituitary incidentalomas.Eur. J. Endocrinol. 2016; 175: 1-9
- Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis.J. Clin. Endocrinol. Metab. 2011; 96: 905-912
- Retrospective multicentric study of pituitary incidentalomas.Pituitary. 2004; 7: 145-148
- Management of endocrine disease: pituitary incidentaloma: neuroradiological assessment and differential diagnosis.Eur. J. Endocrinol. 2016; (pii: EJE-15-1272. [Epub ahead of print])
- Subclinical adenomas in postmortem pituitaries: classification and correlations to clinical data.Eur. J. Endocrinol. 2006; 154: 753-758
- The characteristics of incidental pituitary microadenomas in 120 Korean forensic autopsy cases.J. Kor. Med. Sci. 2007; 22: S61-S65
- Asymptomatic large pituitary adenomas discovered at autopsy.Surg. Neurol. 1996; 46: 28-31
- High prevalence rate of pituitary incidentaloma: is it associated with the age-related decline of the sex hormones levels?.Med. Hypotheses. 2007; 69: 307-309
- Asymptomatic microadenomas of the pituitary gland in an unselected autopsy series.West Indian Med. J. 1986; 35: 275-279
- Pituitary incidentalomas: analysis of a neuroradiological cohort.Pituitary. 2015; 18: 777-781
- Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population.Ann. Intern. Med. 1994; 120: 817-820
- Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study.Radiology. 1997; 202: 41-46
- Incidental pituitary macroadenoma: a population-based study.Am. J. Med. Sci. 1997; 314: 287-291
- Incidental findings on brain MRI in the general population.N. Engl. J. Med. 2007; 357: 1821-1828
- Beckers High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium.J. Clin. Endocrinol. Metab. 2006; 91: 4769-4775
- A survey of pituitary incidentaloma in Japan.Eur. J. Endocrinol. 2003; 149: 123-127
- Pituitary incidentalomas: a single-centre experience.Int. J. Clin. Pract. 2011; 65: 172-177
- Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients.J. Clin. Endocrinol. Metab. 2011; 96: 1633-1641
- The prevalence of pituitary adenomas: a systematic review.Cancer. 2004; 101: 613-619
- Differential diagnosis of sellar masses.Endocrinol. Metab. Clin. North Am. 1999; 28 (vi): 81-117
- The diagnosis and management of parasellar tumours of the pituitary.Endocr. Relat. Cancer. 2008; 15: 885-903
- The natural history of the pituitary incidentaloma.Arch. Intern. Med. 1995; 155: 181-183
- Pituitary adenomas: immunohistology and ultrastructural analysis of 118 tumors.Acta Neuropathol. 1983; 62: 1-14
- The gonadotroph origin of null cell adenomas.Hormones (Athens). 2016; 15: 243-247
- Screening for ACTH-dependent hypercortisolism in patients affected with pituitary incidentaloma.Eur. J. Endocrinol. 2015; 172: 363-369
- Management of endocrine disease: pituitary tumour apoplexy.Eur. J. Endocrinol. 2015; 172: R179-90
- UK guidelines for the management of pituitary apoplexy.Clin. Endocrinol. (Oxf.). 2011; 74: 9-20
- MR imaging findings of Rathke's cleft cysts: significance of intracystic nodules.AJNR Am. J. Neuroradiol. 2000; 21: 485-488
- Characteristics of Rathke's cleft cyst in MR imaging.Magn. Reson. Med. Sci. 2003; 2: 1-8
- Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up.Clin. Endocrinol. (Oxf.). 2005; 62: 397-409
- Craniopharyngioma.Endocr. Rev. 2014; 35: 513-543
- Nonadenomatous tumors of the pituitary and sella turcica.Top. Magn. Reson. Imaging. 2005; 16: 289-299
- Parasellar tumors: suprasellar and cavernous sinuses.Top. Magn. Reson. Imaging. 2005; 16: 307-315
- Primary hypophysitis: clinical-pathological correlations.Eur. J. Endocrinol. 2006; 155: 101-107
- Visual Fields (American Academy of Ophthalmology Monograph Series).3rd edition. Thomas Walsh, 2010
- Endocrine Society Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline.J. Clin. Endocrinol. Metab. 2011; 96: 273-288
- Endocrine Society Acromegaly: an endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab. 2014; 99: 3933-3951
- The diagnosis of cushing's syndrome: an endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab. 2008; 93: 1526-1540
- Hypopituitarism.Lancet. 2016; (pii: S0140-6736(16)30053-8. [Epub ahead of print])
- Do the limits of serum prolactin in disconnection hyperprolactinaemia need re-definition: a study of 226 patients with histologically verified non-functioning pituitary macroadenoma.Clin. Endocrinol. (Oxf.). 2006; 65: 524-529
- Silent corticotroph adenomas.Arq. Bras. Endocrinol. Metabol. 2007; 51: 1314-1318
- Incidentally discovered pituitary lesions: high frequency of macroadenomas and hormone-secreting adenomas—results of a prospective study.Clin. Endocrinol. (Oxf.). 1999; 51: 109-113
- The ‘incidentaloma’ of the pituitary gland. Is neurosurgery required?.JAMA. 1990; 263: 2772-2776
- Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF-1 levels.Clin. Endocrinol. (Oxf.). 2008; 69: 292-298
- Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab. 2016; 101: 364-389
- Endocrine Society Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline.J. Clin. Endocrinol. Metab. 2011; 96: 1587-1609
- American Thyroid Association Task Force on thyroid hormone replacement guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement.Thyroid. 2014; 24: 1670-1751
- Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab. 2006; 91: 1995-2010
S.N. Kalantaridou, D. Dang, S.R. Davis, K.A. Calis, Hormone therapy in women. In: Pharmacotherapy: A pathophysiologic approach, 8th edition, J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells, L.M. Posey, (Editors), (2011).
- Endocrine society treatment of cushing's syndrome: an endocrine society clinical practice guideline.J. Clin. Endocrinol. Metab. 2015; 100: 2807-2831
- Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas.J. Clin. Endocrinol. Metab. 1986; 62: 1173-1179
- Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas.J. Clin. Endocrinol. Metab. 1994; 79: 348-354
- Non-functioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic.Clin. Neurol. Neurosurg. 2013; 115: 2514-2520
- What is the natural history of nonoperated nonfunctioning pituitary adenomas?.Clin. Endocrinol. (Oxf.). 2007; 67: 938-943
- The natural course of non-functioning pituitary macroadenomas.Eur. J. Endocrinol. 2007; 156: 217-224
Article info
Publication history
Published online: August 10, 2016
Accepted:
August 9,
2016
Received:
August 7,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
