Erratum to: Retrospective multicentric study of pituitary incidentalomas

Day, Patricia; Guitelman, Mirtha; Artese, R; Fiszledjer, León; Chervin, Alberto; Vitale, Nicolas; Stalldecker, Graciela; Miguel, Valeria de; Cornaló, Dora; Alfieri, Analía; Mallea-Gil, María Susana

doi:10.1007/s11102-010-0279-7

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“…Most incidentalomas do not grow over time. In the 9 series plus patients from 2 additional series with patients with clinically nonfunctioning adenomas that were not treated surgically, of 166 patients with microadenomas, only 17 patients (10%) experienced tumor growth and of the 356 patients with macroadenomas, only 86 patients (24%) showed evidence of tumor enlargement, on follow-up MRI scans over an 8-year period . Tumor volume–doubling periods range from 0.8 to 27.2 years, emphasizing the tremendous variability in tumor rates of growth.…”

Section: Introductionmentioning

confidence: 99%

“…Clinically nonfunctioning adenomas (defined as no secretion of excess hormones) comprise about one-third of pituitary adenomas and range from being completely asymptomatic (and therefore detected as incidental findings [incidentalomas] on MRI or computed tomography scans performed for other reasons) to causing significant hypothalamic or pituitary dysfunction and visual or other symptoms due to their large size . In the 9 series that reported 454 patients with pituitary incidentalomas, 304 patients (67%) had macroadenomas. This is in sharp contrast to autopsy data, which show that macroadenomas comprise less than 1% of incidental tumors at autopsy, suggesting that there may be some connection between the presence of an “incidental” macroadenoma and the symptom(s) that caused the MRI to be done.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Treatment of Pituitary Adenomas

Molitch

2017

JAMA

731

578

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pproximately 10% of unselected pituitaries (meaning those from individuals without known pituitary disease) examined at autopsy contain pituitary adenomas. 1 Magnetic resonance imaging (MRI) scans of normal volunteers also show a 10% prevalence, 2 but other pathologic entities may have a similar appearance, such as Rathke cleft cysts and metastatic tumors. 3 Not all patients with pituitary tumors develop symptoms because most tumors remain small and most do not secrete hormones in excessive amounts. Clinical case-finding studies, in which all hospitals and practices in a geographic area were queried about cases with pituitary tumors over a defined period, have suggested a prevalence of pituitary adenoma ranging from 1 in 865 persons to 1 in 2688 persons (Table 1). 4,[6][7][8][9][10][11] Pituitary adenomas are classified into microadenomas (<10 mm), macroadenomas (Ն10 mm), and giant adenomas (Ն40 mm) (Figure 1). 12,13 Pituitary carcinomas with distant metastases are rare, occurring in 0.1% to 0.2% of cases. 12 If an MRI shows the tumor impinging on the optic chiasm, then formal visual field testing is indicated. 13 An evaluation for hypopituitarism should be carried out in all patients with macroadenomas and even large (6-9 mm) microadenomas. 1 Diabetes insipidus is rarely seen with pituitary adenomas. 1 About two-thirds of pituitary adenomas may secrete excess hormones. In the studies 4,6-11 that included 1718 patients, about 50% of cases were macroadenomas and 32% to 66% of tumors were secreting prolactin, 14% to 54% were clinically nonfunction-IMPORTANCE Pituitary adenomas may hypersecrete hormones or cause mass effects. Therefore, early diagnosis and treatment are important.OBSERVATIONS Prevalence of pituitary adenomas ranges from 1 in 865 adults to 1 in 2688 adults. Approximately 50% are microadenomas (<10 mm); the remainder are macroadenomas (Ն10 mm). Mass effects cause headache, hypopituitarism, and visual field defects. Treatments include transsphenoidal surgery, medical therapies, and radiotherapy. Prolactinomas account for 32% to 66% of adenomas and present with amenorrhea, loss of libido, galactorrhea, and infertility in women and loss of libido, erectile dysfunction, and infertility in men; they are generally treated with the dopamine agonists cabergoline and bromocriptine. Growth hormone-secreting tumors account for 8% to 16% of tumors and usually present with enlargement of the lips, tongue, nose, hands, and feet and are diagnosed by elevated insulin-like growth factor 1 levels and growth hormone levels; initial treatment is surgical. Medical therapy with somatostatin analogues, cabergoline, and pegvisomant is often also needed. Adrenocorticotropic hormone (ACTH)-secreting tumors account for 2% to 6% of adenomas and are associated with obesity, hypertension, diabetes, and other morbidity. Measurement of a late-night salivary cortisol level is the best screening test but petrosal sinus sampling for ACTH may be necessary to distinguish a pituitary from an ectopic source. The primary treatment of Cushin...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%