Evaluation and management of pituitary incidentalomas—revisiting an acquaintance

Krikorian, Armand; Aron, David C.

doi:10.1038/ncpendmet0122

Cited by 18 publications

(7 citation statements)

References 49 publications

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“…Despite this fact, 12-50% of patients with EAS have undergone inappropriate trans-sphenoidal surgery, with higher rates among patients with occult EAS [6,8,12,13,78]. This could be attributed to the improvements in imaging which has resulted in an increased incidence of pituitary 'incidentalomas' which are unrelated to the source of ACTH [79]. On the other hand, the fact that bronchial carcinoids might be equal or less than 1 cm in diameter, and may be confused with vascular shadows, is a further pitfall for the unwary [24].…”

Section: Specific Considerations In Easmentioning

confidence: 99%

The ectopic ACTH syndrome

Alexandraki

Grossman

2010

Rev Endocr Metab Disord

185

131

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Ectopic Cushing's syndrome usually relates to the ectopic ACTH syndrome (EAS) and represents ∼20% of ACTH-dependent and ∼10% of all types of Cushing's syndrome (CS). Nearly any neuroendocrine or non-endocrine tumours may be associated with EAS, but the more prevalent tumours are bronchial carcinoids, small cell lung carcinomas, pancreatic carcinoids, thymic carcinoids, medullary carcinomas of the thyroid, and phaeochromocytomas. Occult tumours are highly represented in all the series (12-38%) and constitute the more challenging cases of EAS, requiring long term follow-up. The lack of any completely reliable diagnostic test procedure and imaging to clearly reveal the source of EAS suggests that we should adopt a step-by-step multidisciplinary approach for their diagnosis and therapeutic management. Clinical features are often similar in ACTH-dependent CS, but the rapid onset and progress may suggest an ectopic source. A combination of biochemical tests and imaging studies seems the most appropriate approach for the prompt identification of EAS, even if there are several pitfalls to be avoided along the way. The most appropriate management for cure of EAS, when its source is identified, is surgical excision after controlling the hypercortisolaemia by inhibitors of cortisol secretion and other newer modalities alone or in combination; bilateral adrenalectomy remains an alternative option. Tumour histology, the presence of metastases and the effective control of hypercortisolaemia affect mortality and morbidity. If a source repeatedly fails to be found, the prognosis is often favourable but the identification of a malignant tumour should still be sought during life-long follow-up to avoid the calamity of misdiagnosis.

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Section: Specific Considerations In Easmentioning

confidence: 99%

The ectopic ACTH syndrome

Alexandraki

Grossman

2010

Rev Endocr Metab Disord

185

131

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“…Screening for hormone oversecretion in such patients has been questioned as to its cost-effectiveness [60,61]. Evidence from the series of Fainstein Day and colleagues [55] cited previously suggests that such screening is worthwhile, because 7 of their 46 patients turned out to have prolactinomas and of the 13 patients who ended up going to surgery and having immunohistochemistry performed, 2 adenomas (15%) were GH-positive, 3 adenomas (23%) were gonadotropin-positive, and 4 (31%) were plurihormonal adenomas.…”

Section: Endocrinologic Evaluation Of the Asymptomatic Incidental Massmentioning

confidence: 99%

Nonfunctioning Pituitary Tumors and Pituitary Incidentalomas

Molitch

2008

Endocrinology and Metabolism Clinics of North America

163

133

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“…The increased availability and the advances in diagnostic imaging modalities have led to an increased identification of these lesions, which might therefore be termed 'modern technology diseases' [43,44]. Very little is known about the exact incidence and prevalence of asymptomatic incidentalomas in childhood.…”

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—revisiting an acquaintance

Cited by 18 publications

References 49 publications

The ectopic ACTH syndrome

The ectopic ACTH syndrome

Nonfunctioning Pituitary Tumors and Pituitary Incidentalomas

Pituitary Tumors: Advances in Neuroimaging

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