Cost of evaluation of patients with pituitary incidentaloma

Randall, Benjamin R.; Kraus, Kristin L.; Simard, Marie; Couldwell, William T.

doi:10.1007/s11102-010-0241-8

Cited by 19 publications

(9 citation statements)

References 3 publications

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“…Recently it has been recognized that gadolinium-based contrast agents accumulate in the brain, although the clinical significance and long-term effects are unknown [16]. The cost of evaluation of a pituitary incidentaloma was calculated to be $6,215.28 (males) and $6,061.78 (females), which included pituitary hormone labs, 1 follow-up MRI with contrast, neurosurgery and endocrinology consultation, and radiologist fees [17]. Another potential harm of finding a microadenoma is delaying or never starting GH therapy, which occurred in 17% of our cases and may limit potential height gain from the treatment.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

2018

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Background/Aims: Patients with short stature (SS)/growth hormone deficiency (GHD) and precocious puberty (PP) undergo brain MRI to evaluate for structural brain abnormalities or pituitary lesions, and pituitary microadenomas are a common finding. Theoretically, a mass effect from these lesions could cause GHD and growth hormone treatment could cause them to enlarge, but they should not cause PP, at least in females. Methods: We investigated if pituitary microadenomas cause GHD by comparing their incidence in patients with SS/GHD to that in females with PP. We performed a retrospective chart review of patients with these disorders who had a brain MRI between 2000 and 2013. Results: The incidence of microadenoma was high in both groups, 18.5% for SS (n = 346) and 21.1% for PP females (n = 194), but did not differ between groups (p = 0.46). In patients with microadenomas, repeat imaging showed resolution in 58% (SS, n = 33) and 67% (PP females, n = 21). Importantly, none of the lesions grew, even in patients treated with growth hormone. Conclusions: Pituitary microadenomas are common in children with GHD/SS and PP, but it does not appear that they are a cause of GHD. They appear to be of limited clinical significance and should not be considered a contraindication to growth hormone therapy.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

2018

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“…In asymptomatic patients with incidentally found microadenomas, the costs of evaluation can be significant. While data are not widely available for different countries, the US experience suggests the initial evaluation costs >6000 US dollars per patient (not including follow-up assessments) (91).…”

Section: To Treat or Not To Treat?mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary ‘incidentaloma’: neuroradiological assessment and differential diagnosis

Васильев

Rostomyan

Daly

et al. 2016

European Journal of Endocrinology

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Pituitary incidentalomas are a by-product of modern imaging technology. the term 'incidentaloma' is neither a distinct diagnosis nor a pathological entity. Rather, it is a collective designation for different entities that are discovered fortuitously, requiring a working diagnosis based on the input of the radiologist, endocrinologist and often a neurosurgeon. In addition to pathological conditions affecting the pituitary gland, a thorough knowledge of the radiological characteristics of normal variants and technical artifacts is required to arrive at an accurate differential diagnosis. after careful radiological and hormonal evaluation, the vast majority of pituitary incidentalomas turn out to be non-functioning pituitary microadenomas and Rathke's cleft cysts (Rccs). Based on the low growth potential of non-functioning pituitary microadenomas and Rccs, periodic MRI surveillance is currently considered the optimal management strategy. stricter follow-up is required for macroadenomas, as increases in size occur more frequently.

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“…What is the correct and cost-effective approach to this situation, both at diagnosis and during follow-up (Dekkers et al, 2008;King et al, 1997;Randall et al, 2010), considering that sensitivity and specificity of MRI were reported to be of 99% and 29%, respectively (Famini et al, 2011)?…”

Section: Pituitary Incidentalomamentioning

confidence: 99%

Diagnostic Evaluation of the Lesions of the Sellar and Parasellar Region

Attanasio¹,

Cozzi²,

Lasio³

et al. 2012

Explicative Cases of Controversial Issues in Neurosurgery

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A number of other non-neoplastic lesions, such as inflammatory, granulomatous, infectious and/or vascular pathologies can also involve the parasellar region. The different lesions are listed in table 1, according to an etiologic and anatomic classification, and systematically addressed in the following section. Classifications are created to accommodate a large spectrum of entities, from the typical and frequent to the unusual and exceptional, but they are never comprehensive enough to satisfactorily reflect the diversity of nature and the wide range and variety of human diseases (Kovacs et al., 2001). Pituitary adenomas account for about 90% of lesions of the sellar and parasellar region according to different large surgical series: Freda & Post (Freda & Post, 1999) collected 1120 cases in 18 years in a single center, the German Registry of pituitary tumors (Saeger et al., 2007) collected 4122 cases in 10 years, Valassi et al. (Valassi et al., 2010) collected 1469 cases in 10 years in a single center. Thus in ~8-15% of cases, an etiology other than a pituitary adenoma is encountered: other tumors in 4.2-5.6%, malformative lesions in 2.9-5.2%, inflammatory lesions in 0.7-1.2% of cases (Freda & Post, 1999; Saeger et al., 2007; Valassi et al., 2010). In these series vascular lesions are of course underrepresented. A recent radiological series, retrospectively evaluating 2598 MRIs performed over 11 years (Famini et al., 2011), showed that after exclusion of normal pituitaries (47%), nonadenomatous lesions accounted for 18% of observed lesions.

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Cost of evaluation of patients with pituitary incidentaloma

Cited by 19 publications

References 3 publications

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

Incidence and Outcomes of Pituitary Microadenomas in Children with Short Stature/Growth Hormone Deficiency

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary ‘incidentaloma’: neuroradiological assessment and differential diagnosis

Diagnostic Evaluation of the Lesions of the Sellar and Parasellar Region

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