Incidental Pituitary Macroadenoma: A Population-Based Study

Nammour, Gloria M.; Ybarra, Juan; Naheedy, Mohammad H.; Romeo, June Hart; Aron, David C.

doi:10.1097/00000441-199711000-00003

Cited by 58 publications

(40 citation statements)

References 14 publications

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“…Pooling the data of 18 902 subjects in a meta-analysis, Molitch (11) reported that the frequency of pituitary adenomas found at autopsy in subjects with no ante-mortem history of pituitary diseases was 10.7% (range, 1.5-31%), but almost all tumors were tiny microadenomas. In keeping with the autoptic data, pituitary lesions larger than 10 mm in diameter have been described in only 0.2% of 3550 subjects who underwent computed tomography scan for headache or changes in mental status (12). Similarly, only 0.16-0.3% of normal subjects evaluated by magnetic resonance imaging (MRI) had evidence of a pituitary lesion larger than 10 mm (13,14).…”

Section: Introductionmentioning

confidence: 67%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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Objective: Few data are available on the surgical results in patients with incidentally discovered nonfunctioning pituitary adenoma (NFPA). We investigated the efficacy and safety of surgery in patients with incidentally discovered NFPA. Design: Retrospective analysis of prospectively recorded outcomes. Methods: From 1990 to 2011, of 804 consecutive patients undergoing surgery for NFPA, 212 cases had an incidentally discovered tumor (26.4%). Among them, 117 patients were asymptomatic, while 95 had some visual and/or hormonal deficit. The main outcome of the study was to evaluate the frequency of radical resection as judged on the first postoperative neuroimaging study and detection of recurring disease during long-term follow-up. Results: Postoperative residual tumor was detected in 8.9% of patients with asymptomatic incidentalomas as compared with 31.2% of patients with symptomatic incidentalomas (P!0.001) and 41.2% of patients in the control group (P!0.001). Multivariate analysis confirmed that having an asymptomatic incidentaloma was independently associated with a better outcome. The 5-year recurrence-free survival in patients with incidentaloma was 86.8% (95% CI 80.2-92.4%) as compared with 77.9% (95% CI 73.6-82.2%; P!0.01) in the control group. This difference was almost completely due to a lower frequency of relapse in asymptomatic patients. Multivariate analysis confirmed the independent lower risk of tumor recurrence in asymptomatic NFPA. Conclusion: Our study shows for the first time that surgically treated patients with asymptomatic NFPA have a better early and long-term outcome that is independent from all the other demographic, clinical, and morphologic characteristics of the patients.

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Section: Introductionmentioning

confidence: 67%

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

Losa

Donofrio

Barzaghi

et al. 2013

European Journal of Endocrinology

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“…Macroadenoma may cause neurologic symptoms that are not initially seen as implicating adenoma. [16][17][18] and was 0.2% on CT in an observational study in Ohio [19]. There have been isolated case reports of pituitary incidentaloma discovered on PET scan [20].…”

Section: Radiological Seriesmentioning

confidence: 99%

Management of nonfunctioning pituitary incidentaloma

Galland

Vantyghem

Cazabat

et al. 2015

Annales d'Endocrinologie

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Prevalence of pituitary incidentaloma is variable: between 1.4% and 27% at autopsy, and between 3.7% and 37% on imaging. Pituitary microincidentalomas (serendipitously discovered adenoma <1cm in diameter) may increase in size, but only 5% exceed 10mm. Pituitary macroincidentalomas (serendipitously discovered adenoma>1cm in diameter) show increased size in 20-24% and 34-40% of cases at respectively 4 and 8years' follow-up. Radiologic differential diagnosis requires MRI centered on the pituitary gland. Initial assessment of nonfunctioning (NF) microincidentaloma is firstly clinical, the endocrinologist looking for signs of hypersecretion (signs of hyperprolactinemia, acromegaly or Cushing's syndrome), followed up by systematic prolactin and IGF-1 assay. Initial assessment of NF macroincidentaloma is clinical, the endocrinologist looking for signs of hormonal hypersecretion or hypopituitarism, followed up by hormonal assay to screen for hypersecretion or hormonal deficiency and by ophthalmologic assessment (visual acuity and visual field) if and only if the lesion is near the optic chiasm (OC). NF microincidentaloma of less than 5mm requires no surveillance; those of≥5mm are not operated on but rather monitored on MRI at 6months and then 2years. Macroincidentaloma remote from the OC is monitored on MRI at 1year, with hormonal exploration (for anterior pituitary deficiency), then every 2years. When macroincidentaloma located near the OC is managed by surveillance rather than surgery, MRI is recommended at 6months, with hormonal and visual exploration, then annual MRI and hormonal and visual assessment every 6months. Surgery is indicated in the following cases: evolutive NF microincidentaloma, NF macroincidentaloma associated with hypopituitarism or showing progression, incidentaloma compressing the OC, possible malignancy, non-compliant patient, pregnancy desired in the short-term, or context at risk of apoplexy.

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“…Nammour and colleagues [46] found that of 3550 consecutive CT scans done in men with a mean age of 57 years for the symptoms of change in mental status, headache, or possible metastases, 7 (0.2%) demonstrated pituitary macroadenomas ranging from 1.0 to 2.5 cm in size; all were thought to be CNFAs after hormonal evaluation. Similarly, Yue and colleagues [47] found that when 3672 nonenhanced MRI scans were performed without specific views of the sellar area, 0.16% of subjects were found to have adenomas, with all being macroadenomas.…”

Section: Nonfunctioning Pituitary Tumors and Pituitary Incidentalomasmentioning

confidence: 99%