MANAGEMENT OF ENDOCRINE DISEASE: Pituitary ‘incidentaloma’: neuroradiological assessment and differential diagnosis

Васильев, В. Н.; Rostomyan, Liliya; Daly, Adrian; Potorac, Iulia; Zacharieva, Sabina; Bonneville, J. F.; Beckers, Albert

doi:10.1530/eje-15-1272

Cited by 63 publications

(34 citation statements)

References 89 publications

(126 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The widespread use of neuroradiological imaging has resulted in the increasing discovery of collateral findings within the pituitary gland, unrelated to the indication for the original scan. These lesions are called "pituitary incidentalomas" (PIs) [1] and their prevalence is now reported to be around 10% of general population (based on different evaluation modalities) [2,3]. Clinically nonfunctioning pituitary adenomas are the most frequent putative lesions, representing about 3 quarters of PIs [1,2].…”

Section: Introductionmentioning

confidence: 99%

Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

et al. 2019

View full text Add to dashboard Cite

Introduction: Available data on pituitary incidentalomas mostly derive from small-scale studies, with heterogeneous inclusion criteria and limited follow-up. No paper has focused specifically on clinically nonfunctioning pituitary incidentalomas (CNFPIs). Objective: To describe the characteristics and the natural history of patients diagnosed with CNFPIs. Methods: Retrospective multicenter cohort study evaluating hormonal, imaging, and visual field characteristics at diagnosis and during follow-up of CNFPIs investigated in 2 Pituitary Centers. Results: Three hundred and seventy-one patients were included (50.9% microadenomas, 35.6% males). Men were older and more likely to have a macroadenoma (p < 0.01). Totally, 23.7% of patients presented secondary hormonal deficits (SHDs), related to tumor size (higher in macroadenomas; p < 0.001) and age (higher in older patients; p < 0.001). Hypogonadism was the most frequent SHD (15.6%). Two hundred and ninety-six patients had follow-up data, 29.1% required surgery after first evaluation, and 97 had at least 3 years of follow-up. In total, 15.3% adenomas grew (more macroadenomas), but only in microadenomas patients with longer follow-up showed a higher growth trend. Totally, 5.2% of patients developed new SHDs (micro-vs. macroadenomas p = 1.000), and in 60% of them this was not associated with an increase in tumor size. Thir-

show abstract

Section: Introductionmentioning

confidence: 99%

Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The increase in the use of imaging techniques in recent years, mainly magnetic resonance imaging (MRI), has been associated with a noteworthy increase in the incidence of pituitary lesions incidentally discovered, also named pituitary incidentalomas (PIs) [7][8][9]. Its prevalence is very variable and ranges from 11 % in autopsy studies to 4-20 % and 10-38 % in computed tomography (CT) and MRI studies, respectively [10].…”

Section: Introductionmentioning

confidence: 99%

“…Its prevalence is very variable and ranges from 11 % in autopsy studies to 4-20 % and 10-38 % in computed tomography (CT) and MRI studies, respectively [10]. More than 90 % of these PIs are pituitary adenomas, usually CNFPAs, and about 9 % are craniopharyngiomas or Rathke's cleft cysts [9,11,12].…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas

et al. 2017

View full text Add to dashboard Cite

The objective of the study was to assess the prevalence and clinical features of incidentally discovered clinically non-functioning pituitary adenoma (CNFPA) and to analyze its natural history. A multicenter retrospective study in patients diagnosed with incidental CNFPA periodically followed-up in 3 specialized neuroendocrinology units from 1992 to 2015 was performed. Out of a total of 189 CNFPA patients, 57 cases (30.1%; 29 women; age at diagnosis 55.8±16.7 years) were incidental. Most patients (n=55, 96.5%) were diagnosed by magnetic resonance imaging (MRI). A sum of 71.9% (n=41) were macroadenomas; 2 of them (3.5%) were giant adenomas (≥4 cm). Patients with macroadenomas were older than those with microadenomas (59.5±16.7 vs. 46.4±18.1 years, p=0.007). Macroadenomas were more common in men (85.7% vs. 58.6%, p=0.023). Twenty-eight patients (49.1%) showed suprasellar extension; of these, 19 were accompanied by chiasmatic compression. Hypopituitarism was present in 14 (24.6%) patients; which was partial in 13 patients (22.8%) and complete in one patient (1.8%). The gonadal axis was the most frequently affected (n=13, 22.8%). Twenty four patients (42.1%) underwent surgery. Of the non-operated patients, 26 patients could be evaluated morphologically after a median follow-up of 15.5 months (interquartile range, 5.7-32.7 months). No significant changes were found in the maximum tumor diameter at the end of follow-up (1.2±0.6 vs 1.2±0.7 cm). The majority of CNFPAs evaluated (n=23, 88.5%) did not show any changes in size. In 2 cases (7.7%) tumor size decreased, and in one patient (3.8%) increased. In our series of CNFPA patients, approximately one-third were incidental. These tumors were diagnosed by MRI preferably from the 5th decade of life without sex predilection. Most of them were macroadenomas, more commonly diagnosed in men and at an older age, compared to microadenomas. The suprasellar extension with chiasmatic compression and hypopituitarism were frequent at diagnosis. Most of the non-operated incidental CNFPAs remain with stable tumor size over time, growth being an unusual event.

show abstract

“…His prolactin levels indicated that the tumor was a prolactinoma. The differential diagnosis of sellar masses includes adenohypophysis and neurohypophysis tumors, parasellar tumors, malignant tumors, malformation lesions, granulomatous and inflammatory lesions, and vascular lesions [6–8]. This patient had an enormous mass that invaded neighboring structures and the base of the skull with full invasion of the sphenoid and cavernous sinuses.…”

Section: Discussionmentioning

confidence: 99%

“…Increased cerebral dopaminergic tone due to the use of dopamine, bromocriptine, or cabergoline agonists may trigger psychiatric symptoms such as compulsive shopping behavior or sexual activity, gambling, and robbery; schizophrenia; psychoses; and intermittent explosive disorder [2]. The diagnosis of prolactinoma can be an incidental encounter when investigating some signs and symptoms related to other diseases [6–8].…”

Section: Introductionmentioning

confidence: 99%

Giant cabergoline-resistant prolactinoma in a man who presented with a psychotic episode during treatment: a case report

Casulari

Castro

Kessler³

et al. 2019

J Med Case Reports

View full text Add to dashboard Cite

Background Prolactinomas are tumors of the pituitary gland that usually respond very well to treatment with cabergoline. Resistance to cabergoline is very rare, but when it occurs, it is a difficult problem to resolve if the tumor is inoperable. Case presentation A 62-year-old white man was treated for a giant macroprolactinoma detected during investigation of a subacute subdural hematoma of the left frontal lobe. The patient was treated with cabergoline for 17 years with a dose ranging from 1.0 mg to 3.5 mg per week. We were not able to normalize his prolactin level, which initially was 14,992 ng/ml and ultimately 1754 ng/ml. The tumor significantly shrank during the follow-up period but persisted. The patient had cardiac valvulopathies that did not worsen. He had an ischemic stroke and developed a psychotic condition that was successfully treated by lowering the cabergoline and administering quetiapine and mirtazapine together. This regimen led to a small increase in the patient’s prolactin that returned to previous levels and remained as such until the last medical evaluation. The tumor continued to shrink and had a cystic degeneration in the last evaluation. Conclusions Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in our patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors.

show abstract

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary ‘incidentaloma’: neuroradiological assessment and differential diagnosis

Cited by 63 publications

References 89 publications

Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

Prevalence, Clinical Features, and Natural History of Incidental Clinically Non-Functioning Pituitary Adenomas

Giant cabergoline-resistant prolactinoma in a man who presented with a psychotic episode during treatment: a case report

Contact Info

Product

Resources

About