Incidental pituitary adenomas

Parent, Andrew D.; Bebin, José; Smith, Robert R.

doi:10.3171/jns.1981.54.2.0228

Cited by 109 publications

(46 citation statements)

References 3 publications

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“…However, even today, pituitary adenomas are a common incidental finding at the time of autopsy. 3,4 With wider application of computed tomography (CT) and magnetic resonance imaging (MRI), pituitary masses will be detected incidentally during patients' lifetimes in increasing frequency. The diagnostic and therapeutic approach to patients with "incidentalomas" of the pituitary gland has not yet been established.…”

mentioning

confidence: 99%

The 'incidentaloma' of the pituitary gland. Is neurosurgery required?

Reincke¹

1990

JAMA: The Journal of the American Medical Association

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confidence: 99%

The 'incidentaloma' of the pituitary gland. Is neurosurgery required?

Reincke¹

1990

JAMA: The Journal of the American Medical Association

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“…In corroboration of these indirect investigations of pituitary anatomy, pituitary microadenomas have been observed in up to 20% of sequential autopsy analyses of the hypophysis (2,3). Although several prospective studies have indicated that most pituitary microadenomas detected incidentally in imaging studies have an extremely benign course (4,5), it is also quite obvious that pituitary macroadenomas must undergo an apparent 'microadenomatous phase'.…”

Section: Introductionmentioning

confidence: 73%

Effect of TRH on beta-gonadotropin subunits in patients with pituitary microincidentalomas

Greenman

Trostanetsky²,

Sömjen³

et al. 1999

European Journal of Endocrinology

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Objective: To explore the hypothesis that most of the pituitary abnormalities compatible with the diagnosis of microadenoma, and detected in about 10% of the normal adult population, represent asymptomatic gonadotropinomas. Design: Patients diagnosed with pituitary microincidentalomas at the Institute of Endocrinology of the Tel Aviv Medical Center were evaluated. Circulating b-subunits of gonadotropin hormones were measured before and 30, 45, 60 and 90 min after the intravenous injection of 400 mg TRH. Patients: Twenty-two patients with pituitary incidentaloma and 16 normal volunteers were tested. Results: In 16 of the 22 patients, an abnormal b-subunit response was detected after the TRH challenge. Three patients had an abnormal increase in both b-FSH and b-LH after TRH administration. Isolated pathological b-FSH or b-LH responses were demonstrated in five and eight patients respectively. Six patients had normal basal and stimulated gonadotropin subunit values, raising the possibility that their lesions were not pituitary microadenomas. There was a significant overall difference between the response to TRH of the patient and control groups. In the gonadotropin positive group, comprising 16 patients, serum b-FSH increased from 6.4Ϯ1.6 ng/ml to 9.2Ϯ1.3 ng/ml (P=0.042) 1 h after TRH stimulation, whereas no changes were detected in the control group after TRH injection (basal: 4.1Ϯ0.8 ng/ml, peak: 5.1Ϯ0.8 ng/ml; P=0.15). Serum b-LH increased from 10.5Ϯ3.2 ng/ml to 23.4Ϯ4.9 ng/ml (P=0.0037) at this time, in contrast to a lack of response in controls (basal: 6.4Ϯ1.5 ng/ml, peak: 8.2Ϯ2.3 ng/ml; P=0.24). Conclusion: In about 73% of patients with pituitary incidentalomas smaller than 10 mm, TRH elicits an increase in gonadotropin b-subunits. This observation raises the possibility that non-functioning pituitary micro-and macroadenomas, which share a similar response to TRH, originate in a common ancestor cell type, probably a pituitary gonadotrope.

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“…Dilution of serum samples must be specifically requested if suspicion of the hook effect is high enough. 8,13,14 Of the major anterior pituitary hormonal axes, the two that typically require the most attention with regard to hormonal replacement prior to any intervention are the cortisol and thyroid axes. Medical replacement of hypofunctioning cortisol or thyroid axes should be implemented prior to any operation, typically in collaboration with an endocrinologist.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist

Christian

Harris

Wrobel

et al. 2014

FOC

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Endoscopic endonasal surgery relies heavily on specialized operative instrumentation and optimization of endocrinological and other critical adjunctive intraoperative factors. Several studies and worldwide initiatives have previously established that intraoperative and perioperative surgical checklists can minimize the incidence of and prevent adverse events. The aim of this article was to outline some of the most common considerations in the perioperative and intraoperative preparation for endoscopic endonasal transsphenoidal surgery. The authors implemented and prospectively evaluated a customized checklist at their institution in 25 endoscopic endonasal operations for a variety of sellar and skull base pathological entities. Although no major errors were detected, near misses pertaining primarily to missing components of surgical equipment or instruments were identified in 9 cases (36%). The considerations in the checklist provided in this article can serve as a basic template for further customization by centers performing endoscopic endonasal surgery, where their application may reduce the incidence of adverse or preventable errors associated with surgical treatment of sellar and skull base lesions.

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Incidental pituitary adenomas

Cited by 109 publications

References 3 publications

The 'incidentaloma' of the pituitary gland. Is neurosurgery required?

The 'incidentaloma' of the pituitary gland. Is neurosurgery required?

Effect of TRH on beta-gonadotropin subunits in patients with pituitary microincidentalomas

Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist

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