Incidence of Pituitary Incidentalomas in Patients with Adrenal Adenomas

Abstract

With the advent of modern imaging modalities, endocrine incidentalomas are increasingly being discovered. We aimed to investigate the presence of pituitary incidentalomas (PI) in patients with adrenal incidentalomas (AI), and identify potential metabolic correlates in this cohort. 26 patients (18 females) with AI discovered on abdominal computerized tomography were studied. All patients underwent pituitary magnetic resonance imaging (MRI) and endocrine investigations to evaluate functional adrenal pathology, anterior pituitary hormonal status, insulin-resistance indices and presence of metabolic syndrome. Pituitary MRI revealed a microadenoma and a 4×5 mm cyst in 1 patient respectively, and an empty sella in 4 (2 partial) patients. Overall, 6/26 (23%) patients with an AI had evidence of pituitary imaging pathology but only 8% had a PI; none had any evidence of abnormalities in pituitary function. Subclinical hypercortisolism was the only hyperfunctional status detected in 4 patients with AI but was unrelated to the pituitary findings. No abnormality of insulin secretion and action was found between patients with or without pituitary pathology. In the present study 23% of patients with AI had some alteration in pituitary morphology, and 2 a PI without accompanying pituitary hormonal deficit or metabolic derangement. Further studies are required to address this issue and identify a potential pathogenetic mechanism.

Adrenal Incidentalomas and Other Endocrine-Related Adenomas: How Much Does Cortisol Secretion Matter?

“…Due to the small size of many pituitary lesions, the fact that many are nonfunctioning pituitary adenomas or that they might present with a very mild hormone secretion, it is a challenge to accurately measure the real prevalence of pituitary adenomas in the general population [43]. Chrisoulidou et al described a prevalence of 8% of pituitary adenomas in patients with adrenal incidentalomas [44]. In contrast, the prevalence rate in our cohort was almost half (4.1%).…”

“…In contrast, the prevalence rate in our cohort was almost half (4.1%). Similarly, MACS was not associated with the presence of pituitary adenomas [44]. Despite this, it has been described that almost 23% of patients with adrenal incidentaloma present an alteration in the pituitary gland morphology, suggesting that an altered mechanism could affect cell proliferation on both glands.…”