Evaluation and management of pituitary incidentalomas

Serhal, Dina; Weil, Robert J.; Hamrahian, Amir H.

doi:10.3949/ccjm.75.11.793

Cited by 28 publications

(14 citation statements)

References 34 publications

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“…In older patients without visual deficit, a more conservative approach might be preferred (16,17). Even in patients with asymptomatic NFPA, immediate surgery might be considered, but most authors recommend clinical and neuroradiological follow-up as first option (15,18,19). However, these recommendations are not based on hard evidence because large and comparative studies on this topic are lacking.…”

Section: Introductionmentioning

confidence: 99%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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Objective: Few data are available on the surgical results in patients with incidentally discovered nonfunctioning pituitary adenoma (NFPA). We investigated the efficacy and safety of surgery in patients with incidentally discovered NFPA. Design: Retrospective analysis of prospectively recorded outcomes. Methods: From 1990 to 2011, of 804 consecutive patients undergoing surgery for NFPA, 212 cases had an incidentally discovered tumor (26.4%). Among them, 117 patients were asymptomatic, while 95 had some visual and/or hormonal deficit. The main outcome of the study was to evaluate the frequency of radical resection as judged on the first postoperative neuroimaging study and detection of recurring disease during long-term follow-up. Results: Postoperative residual tumor was detected in 8.9% of patients with asymptomatic incidentalomas as compared with 31.2% of patients with symptomatic incidentalomas (P!0.001) and 41.2% of patients in the control group (P!0.001). Multivariate analysis confirmed that having an asymptomatic incidentaloma was independently associated with a better outcome. The 5-year recurrence-free survival in patients with incidentaloma was 86.8% (95% CI 80.2-92.4%) as compared with 77.9% (95% CI 73.6-82.2%; P!0.01) in the control group. This difference was almost completely due to a lower frequency of relapse in asymptomatic patients. Multivariate analysis confirmed the independent lower risk of tumor recurrence in asymptomatic NFPA. Conclusion: Our study shows for the first time that surgically treated patients with asymptomatic NFPA have a better early and long-term outcome that is independent from all the other demographic, clinical, and morphologic characteristics of the patients.

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Section: Introductionmentioning

confidence: 99%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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“…Diagnosis currently relies on radiological features of CT or MRI, usually after the appearance of mass effects due to compression, but NFPA are sometimes only discovered as incidentalomas. 7,8,14 To FIGURE 1: Protein peak clustering analysis (Biomarker Wizard plot) for the patients with nonfunctioning pituitary adenoma (NFPA group; n = 34) compared with healthy age-and sex-matched control subjects (healthy group; n = 34) X Hu, P Zhang, A Shang et al…”

Section: Discussionmentioning

confidence: 99%

A Primary Proteomic Analysis of Serum from Patients with Nonfunctioning Pituitary Adenoma

Zhang

Shang³

et al. 2012

J Int Med Res

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OBJECTIVE:The early diagnosis of nonfunctioning pituitary adenoma (NFPA) is difficult. The objective of this study was to find specific protein biomarkers to aid in the early detection of NFPA. METHODS: Serum samples from 34 patients with NFPA and 34 age-and sex-matched healthy control subjects were analysed using surface-enhanced laser desorption/ ionization time-of-flight mass spectrometry (SELDI-TOF-MS) technology. The spectra were generated, protein peak clustering was performed and classification analyses were carried out using a decision tree classification algorithm. RESULTS: Nine differentially expressed serum proteins were identified in the patients with NFPA compared with the control subjects. Both the sensitivity and specificity of the decision tree classification algorithm were 82

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“…Hormonally active prolactin-secreting tumors can be treated with dopamine agonists. Other hormonally active tumors and those that are causing a mass effect should be surgically removed [46].…”

Section: Incidentalomasmentioning

confidence: 99%

Pituitary Tumors: Advances in Neuroimaging

Morana¹,

Maghnie

Rossi³

2009

Pediatric Neuroendocrinology

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Pediatric pituitary tumors, albeit relatively infrequent, can significantly alter the quality of life of affected children. Accurate diagnostic differentiation is essential for both safe and effective disease management. Recent advances in neuroimaging have enabled the neuroradiologist to study the pituitary region in greater detail than ever before. Magnetic resonance imaging (MRI) represents the examination method of choice for evaluating hypothalamic-pituitary-related endocrine diseases due to its ability to provide strongly contrasted high-resolution, multiplanar and spatial images. Specifically, MRI allows the detection of the pituitary lesions responsible of the clinical picture and offers useful information about the relationship with adjacent anatomical structures in order to plan the medical or surgical strategy. A rigorous imaging exam technique is necessary in order to obtain images of high diagnostic quality. Advanced MR techniques, including diffusion-weighted imaging and MR spectroscopy, may be helpful in particular cases. Computerized tomography (CT) has a complementary role in the identification of intralesional calcifications or to better evaluate bone structures prior to trans-sphenoidal surgery. The aim of this work is to provide an overview of the most relevant neuroradiological features of pituitary region tumors and to propose an appropriate and accurate differential diagnosis.

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Evaluation and management of pituitary incidentalomas

Cited by 28 publications

References 34 publications

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

A Primary Proteomic Analysis of Serum from Patients with Nonfunctioning Pituitary Adenoma

Pituitary Tumors: Advances in Neuroimaging

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