Pituitary incidentaloma

Constantinescu, Stefan Matei; Maiter, Dominique

doi:10.1016/j.lpm.2021.104081

Cited by 10 publications

(12 citation statements)

References 61 publications

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“…The 2021 German guideline on the diagnosis of clinically non-functioning pituitary adenomas similarly recommends screening for all anterior pituitary hormones at initial presentation, except for cortisol, in which measurement is recommended for larger tumours only (≥ 6 mm) [ 24 ]. Others stipulate the evaluation for any form of hypopituitarism is unnecessary for smaller tumours (< 5 mm), but for clinicians to consider assessment for those measuring > 5 mm [ 23 , 26 , 37 , 39 ]. Debate most likely arises due to variance in the reported rates of hypopituitarism [ 12 – 16 , 19 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Debate most likely arises due to variance in the reported rates of hypopituitarism [ 12 – 16 , 19 , 40 ]. Furthermore, whilst some provide guidance based on size of microadenoma [ 23 , 26 , 37 , 39 ], evidence to support a specific threshold is still lacking. Of note, two recent studies with a comparatively large cohort of clinically NFPAs were unable to demonstrate a significant difference in the prevalence of hypopituitarism between those smaller than 5 mm and those sized 5–9 mm [ 16 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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UK practice on incidentally detected non-functioning pituitary microadenomas: analysis of two national surveys during a 12-year interval

et al. 2022

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Purpose The optimal management approach for presumed non-functioning pituitary microadenomas (microNFPAs) remains unclear. Our aim was to capture current UK practice and identify changes with time. Methods Two online surveys investigating clinicians’ approaches were performed in 2009–2010 and 2021–2022 (advertised through Society for Endocrinology UK). Results 150 and 214 clinicians participated in the 2021 and 2009 survey, respectively (response rates 31.2% and 35.4%, respectively). At baseline, 2021 survey respondents were more likely to measure IGF-1 (96.0% vs 74.1%, p < 0.001) and morning cortisol (87.9% vs 62.6%, p < 0.001), and less likely GH (26.2% vs 42.6% p = 0.002), 24 h urine free cortisol (3.4% vs 23.2%, p < 0.0001) or dynamically assess adrenal reserve (11.4% vs 30.4%, p < 0.001). 47.2% of clinicians in 2021 would reassess pituitary function annually until discharge (in absence of tumour growth/symptoms). The 2021 survey respondents were more likely to stop imaging at or before 3 years (81.7% vs 44.3%, p < 0.001) and at or before 5 years (86.6.% vs 72.9%, p = 0.002), whilst 2009 survey respondents were more likely to continue imaging beyond 5 years (24% vs 7%, p < 0.001). Responses on imaging frequency/intervals showed notable variability in both surveys. Conclusions Diagnostic and management approaches for microNFPAs have evolved in the UK. Biochemical investigations are performed in accord with consensus guidelines, though many clinicians perform annual biochemical surveillance without tumour growth/symptoms. A small number of clinicians request imaging beyond 5 years, but the frequency of imaging intervals until discharge remains variable. Robust evidence on the long-term natural history of microNFPAs is necessary to unify clinician approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

UK practice on incidentally detected non-functioning pituitary microadenomas: analysis of two national surveys during a 12-year interval

et al. 2022

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“…Pituitary incidentaloma (PI) refers to a lesion around the pituitary gland that is inadvertently detected during an imaging examination for reasons unrelated to pituitary concerns [ 1 2 3 ]. The name describes the fortuitous nature of its discovery, and PIs histologically correspond to a wide range of diseases [ 3 ]. Pituitary adenoma is the most common neoplastic lesion and Rathke’s cleft cyst (RCC) is the most common cystic lesion [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…If the PI is accompanied by tumor-related symptoms, such as headache or visual disturbance, or presents as a functional lesion, it is treated with surgery, bromocriptine, or cabergoline. Except for pituitary apoplexy, the etiological link between headache and a pituitary lesion is hardly proven [ 3 ]. In the case of an asymptomatic non-functional lesion, the patient is followed up periodically [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…For asymptomatic non-functional micro-incidentaloma, available guidelines recommend an annual MRI for 3 years [ 4 ] or at 6 months, 1 year, and 2 years [ 5 ]. While there is a general consensus regarding follow-up periods in existing guidelines, some details remain inconsistent, for example, the follow-up period for non-functional pituitary micro-incidentaloma [ 3 ]. Thus, the present study analyzed neuroradiological data from asymptomatic patients with non-functional PI who did not require surgery or medication at the time of diagnosis and assessed to suggest follow-up periods for PI based on MRI characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Suggestion of Follow-Up Period in Nonfunctioning Pituitary Incidentaloma Based on MRI Characteristics

Jung,

Yang,

Cho

2024

Brain Tumor Res Treat

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Background For patients diagnosed with asymptomatic, non-functional pituitary incidentaloma (PI), periodic follow-up is generally proposed. However, the recommended follow-up period differs among existing guidelines and consensus is lacking. Thus, this study aimed to suggest follow-up periods for PI based on MRI characteristics. Methods Between 2007 and 2023, 245 patients who were diagnosed with PI were retrospectively assessed. Their mean clinical and neuroradiological follow-up periods were 74.2 and 27.3 months, respectively. Their baseline clinical and neuroradiological characteristics were analyzed. These 245 patients were divided into two groups: those with PI size progression and those without PI size progression. Additionally, neuroradiological features of each group were analyzed according to presumptive diagnoses of PI. Results PI size increased in 33 of 245 patients. For the remaining 212 patients, PI size decreased or stayed unchanged. Of the 33 patients with PI size progression, ten underwent surgery. Stalk deviation ( p <0.001) and lesion enhancement ( p =0.001) were significantly more observed in those with PI size progression than in those without PI size progression. MRI morphological factors were not related to changes in PI size in the presumptive Rathke’s cleft cyst group. In the presumptive pituitary adenoma group, absence of tumor enhancement ( p <0.001) and stalk deviation ( p <0.001) were significantly associated with tumor reduction and progression, respectively. Conclusion Our findings support an additional guideline for patients with asymptomatic non-functional PI without stalk deviation and enhancement. For these patients, the clinical and neuroradiological follow-up periods could be reduced.

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Imaging of pituitary tumors: an update with the 5th WHO Classifications—part 2. Neoplasms other than PitNET and tumor-mimicking lesions

Tsukamoto¹,

Miki²

2023

Jpn J Radiol

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Many types of tumors can develop in the pituitary gland. In the recently revised 5th editions of the World Health Organization (WHO) classifications (2021 WHO Classification of Central Nervous System Tumors and the 2022 WHO Classification of Endocrine and Neuroendocrine Tumors), various changes have been made to the tumors other than pituitary neuroendocrine tumor (PitNET)/pituitary adenoma, as well as PitNET. Adamantinomatous craniopharyngioma and papillary craniopharyngioma are now considered separate tumors in the 5th edition of the WHO classification. Tumors positive for thyroid transcription factor 1, a marker of posterior pituitary cells, are now grouped together in the pituicyte tumor family in the 5th edition of the WHO classification of Endocrine and Neuroendocrine Tumors. Poorly differentiated chordoma is newly listed in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. In this paper, we present the latest WHO classification of pituitary tumors (adamantinomatous craniopharyngioma, papillary craniopharyngioma, pituitary blastoma, pituicyte tumor family, tumors of pituitary origin other than those of the pituicyte tumor family, germinoma, meningioma, chordoma, metastatic tumors, lymphoma, and pituitary incidentaloma), review diseases requiring differentiation from tumors (pituitary abscess, hypophysitis, pituitary hyperplasia, Rathke’s cleft cyst, arachnoid cyst, and aneurysm), and discuss diagnoses based on imaging findings.

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Pituitary incidentaloma

Cited by 10 publications

References 61 publications

UK practice on incidentally detected non-functioning pituitary microadenomas: analysis of two national surveys during a 12-year interval

UK practice on incidentally detected non-functioning pituitary microadenomas: analysis of two national surveys during a 12-year interval

Suggestion of Follow-Up Period in Nonfunctioning Pituitary Incidentaloma Based on MRI Characteristics

Imaging of pituitary tumors: an update with the 5th WHO Classifications—part 2. Neoplasms other than PitNET and tumor-mimicking lesions

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