Incidentalomas hipofisários

Vilar, Lúcio; Azevedo, Monalisa F.; Barisic, Gilka; Naves, Luciana Ansaneli

doi:10.1590/s0004-27302005000500006

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…Abnormal pituitary images (microadenomas, cystic lesions, empty sella or, less frequently, macroadenomas) have been reported in 8-26% of patients with macroprolactinemia (21,43,44,59,65) but this frequency is similar to that found in the general population (6-20%) (80,81). However, in a recent study involving 88 macroprolactinemic patients, 65% had abnormal MRI, compared with 81% of 244 subjects with monomeric hyperprolactinemia (44).…”

Section: Imaging Studiesmentioning

confidence: 84%

“…On the other hand, at least 10% of the general adult population undergoing dedicated imaging have a possible pituitary microadenoma (80,81). Thus, the lesion seen on the MRI may be an incidental finding in patients whose hyperprolactinemia has other etiologies: drug-induced systemic disease, or macroprolactin predominance (44,59,61,65,68).…”

Section: Imaging Studiesmentioning

confidence: 99%

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Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

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The definition of the etiology of hyperprolactinemia often represents a great challenge and an accurate diagnosis is paramount before treatment. Although prolactin levels > 200-250 ng/mL are highly suggestive of prolactinomas, they can occasionally be found in other conditions. Moreover, as much as 25% of patients with microprolactinomas may present prolactin levels < 100 ng/mL, which are found in most patients with pseudoprolactinomas, drug-induced hyperprolactinemia, or systemic diseases. On the other hand, some conditions may lead to falsely low PRL levels, particularly the so-called hook effect, that is an assay artifact caused by an extremely high level of PRL, and can be confirmed by repeating assay after a 1:100 serum sample dilution. The hook effect must be considered in all patients with large pituitary adenomas and PRL levels within the normal range or only modestly elevated (e.g., < 200 ng/mL). An overlooked hook effect may lead to incorrect diagnosis and unnecessary surgical intervention in patients with prolactinomas. Another important challenge is macroprolactinemia, a common finding that needs to be identified, as it usually requires no treatment. Although most macroprolactinemic patients are asymptomatic, many of them may present galactorrhea or menstrual disorders, as well as neuroradiological abnormalities, due to the concomitance of other diseases. Finally, physicians should be aware that pituitary incidentalomas are found in at least 10% of adult population. Arq Bras Endocrinol Metab. 2014;58(1):9-22 Keywords Hyperprolactinemia; diagnostic pitfalls; hook effect; macroprolactinemia; pituitary incidentalomas RESUMO A definição da etiologia da hiperprolactinemia muitas vezes representa um grande desafio e um diagnóstico preciso é fundamental antes do tratamento. Embora níveis de prolactina > 200-250 ng/mL sejam altamente sugestivos de prolactinomas, ocasionalmente podem ser encontrados em outras condições. Além disso, até 25% dos pacientes com microprolactinomas podem apresentar-se com níveis de prolactina < 100 ng/mL, os quais são evidenciados na maioria dos pacientes com pseudoprolactinomas, hiperprolactinemia induzida por drogas ou doenças sistêmicas. Por outro lado, deve--se atentar às condições que podem levar a valores de prolactina falsamente baixos, particularmente o chamado efeito gancho. Este último é um artefato causado por um nível extremamente elevado de PRL e que pode ser confirmado pela repetição do exame após diluição do soro a 1:100. O efeito gancho deve ser considerado em todo paciente com grandes adenomas hipofisários e níveis de prolactina dentro da faixa normal ou apenas moderadamente elevados (p. ex., < 200 ng/mL). Um efeito gancho não detectado pode levar a diagnóstico incorreto e intervenção cirúrgica desnecessária em pacientes com prolactinomas. Outro desafio importante é a macroprolactinemia, um achado comum que precisa ser identificado visto que geralmente não requer tratamento. Ainda que a maioria dos pacientes seja assintomática devido à concomitância de outr...

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Section: Imaging Studiesmentioning

confidence: 84%

Section: Imaging Studiesmentioning

confidence: 99%

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Vilar

Fleseriu

Bronstein

2014

Arq Bras Endocrinol Metab

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“…The last search was conducted the 7th of May 2023 and as shown in Fig. 1 , Table 1 , and Table S2 , we included 35 publications reporting on 30 studies 4 5 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 . The included studies represent data from 1957 patients with NFPTs who were initially treated conservatively and followed for a mean of 4.0 (SD 1.5) years.…”

Section: Resultsmentioning

confidence: 99%

Natural History of Non-Functioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

Rikvold,

Pedersen,

Andreassen

et al. 2023

Horm Metab Res

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The management of non-functioning pituitary tumors (NFPTs) relies on the risk of tumor growth and new endocrinopathies. The objective of this systematic review was to assess the risk of growth, new pituitary endocrinopathies, and surgery in patients with conservatively treated NFPTs. We conducted a bibliographical search identifying studies assessing NFPTs followed conservatively. Estimates were pooled using random-effects meta-analysis reporting events per 100 person years (PYs), in case of high heterogeneity (I2>75%) only the range of observed effects was reported. We identified 30 cohort studies including 1957 patients with a mean follow-up time of 4.0 (SD 1.5) years. The overall risk of tumor growth ranged from 0.0 to 14.2/100 PYs (I2=90%), while the overall risk of new endocrinopathies was 0.9/100 PYs (95% CI. 0.5 to 1.2; I2=35%) and risk of surgery ranged from 0.0 to 7.7/100 PYs (I2=80%). Compared to microadenomas, macroadenomas had higher risk of growth (p=0.002), higher risk of surgery (p=0.006), and non-significant differences in risk of new endocrinopathies (p=0.15). An analysis of microadenomas found the risk of growth to be 1.8/100 PYs (95% CI. 0.9 to 2.8; I2=58%), the risk of new endocrinopathies 0.7/100 PYs (95% CI. 0.0 to 1.6; I2=37%) and the risk of surgery 0.5/100 PYs (0.1 to 0.9; I2=37%). These data support individualized follow-up strategies of patients with NFPTs and particularly a less rigorous follow-up of patients with microadenomas.

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“…(13), 17 de 66 (26%) dos pacientes com SAE tinham uma RM hipofisária anormal. Ademais, incidentalomas hipofisários e adrenais são encontrados, respectivamente, em 10% e até 4% da população adulta geral (1,18,43). Portanto, os exames de imagem isoladamente não permitem a definição da etiologia do hipercortisolismo.…”

Section: Discussionunclassified

Síndrome de cushing endógena: características clínico-laboratoriais em 73 casos

Vilar¹,

Naves

Freitas

et al. 2007

Arq Bras Endocrinol Metab

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We studied clinical and laboratorial features of 73 patients with endogenous Cushing's syndrome, subdivided as follows: 46 (63%) with Cushing's disease (CD), 21 (28.7%) with an adrenal tumor and 6 (8.2%) with ectopic ACTH secretion (EAS). The rate of typical manifestations of hypercortisolism was similar regardless its etiology. In 100% of cases of Cushing's syndrome we observed serum cortisol levels greater than 1.8 microg/dL in low-dose dexamethasone (DMS) suppression tests, as well as elevation of serum or salivary midnight cortisol. However, urinary free cortisol was normal in 11.5% of patients. ACTH levels were suppressed in patients with adrenal tumors, normal or high in CD and always high in EAS. In the 8-mg overnight DMS suppression test, serum cortisol suppression > 50% was observed in 78.2% of cases of CD and in 33.3% of subjects with EAS, while an 80% suppression was only seen in CD. After stimulation with CRH or DDAVP an ACTH increase > 35% occurred in 81% of individuals with CD and 16.6% of those with EAS, while an ACTH increase > 50 achieved 100% specificity. Moreover, the combination of serum cortisol suppression > 50% and an ACTH increase > 35% in both tests only occurred in Cushing's disease. Pituitary magnetic resonance imaging identified 100% of macroadenomas and 59.4% of microadenomas in patients with CD. Among 10 patients that underwent bilateral inferior petrosal sinus sampling, a central-to-peripheral ACTH gradient > 3 after CRH or DDAVP had 90% sensitivity and 100% specificity for Cushing's disease.

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Incidentalomas hipofisários

Cited by 3 publications

References 21 publications

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Challenges and pitfalls in the diagnosis of hyperprolactinemia

Natural History of Non-Functioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

Síndrome de cushing endógena: características clínico-laboratoriais em 73 casos

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