Management of pituitary incidentalomas

Westall, Samuel; Aung, Ei Thuzar; Kejem, Helmine; Daousi, Christina; Thondam, Sravan

doi:10.7861/clinmed.2023-0020

Cited by 5 publications

(1 citation statement)

References 14 publications

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“…Since there has been no study analyzing changes in PI size over the follow-up period based on neuroradiological characteristics, our study has strengths in this respect. Considering the lack of consensus regarding the management of micro-PIs from available guidelines [ 1 3 4 5 27 ] and that repetitive and long-term clinical and neuroradiological follow-ups can increase patient time and cost burdens and exhaust healthcare resources [ 2 ], our findings may offer an alternative to address this.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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Clinical Impact of New Reference Intervals for the Roche Prolactin II Immunoassay

Gad,

Tee,

Boot

et al. 2024

Clinical Endocrinology

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Dear Editor, Recently, a new upper limit of normal (ULN) range for the Roche Prolactin II immunoassay has been proposed by Earll et al. [1] The authors investigated 374 serum samples from healthy outpatients and suggested a new ULN for the Roche II assay of 37.8 ng/mL or 804 mIU/L (females) and 22.8 ng/mL or 485 mIU/L (males). They concluded that adopting these reference intervals would not delay diagnosis or prevent necessary intervention in patients with clinically significant pituitary tumours but reduces unnecessary investigations. Interestingly, the authors did not validate their new cut-offs in patients with pituitary disease-causing hyperprolactinaemia.We recently published the utility of cannulated prolactin testing in a cohort of 55 females of reproductive age referred to our institution (Royal Victoria Infirmary, Newcastle upon Tyne, UK) with mild hyperprolactinaemia (< 10 × ULN) on repeat random sampling [2]. All patients were referred following primary care physician review with either symptoms of hyperprolactinaemia or other symptoms prompting a serum prolactin check. Serum prolactin concentrations were measured by sandwich immunoassay using the Roche Prolactin II immunoassay (Roche Diagnostics). The prolactin reference range for females used in our laboratory is manufacturer-defined (102−496 mIU/L or 4.8−23.3 ng/mL). We re-analysed the referral prolactin concentrations in our cohort to investigate the performance of the newly proposed ULN (37.8 ng/mL or 804 mIU/L) for females.

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A Study in Pituitary Neuroendocrine Tumors (PitNETs): Real-Life Data Amid Baseline and Serial CT Scans

Costachescu,

Sima,

Stanciu

et al. 2024

Cancers

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Non-functioning (NF) accidentally detected PitNETs (PIs) are common findings of CT/MRI scans currently. Data concerning their behavior vary, and some PIs will potentially experience a size change over time that might become clinically relevant. Objective: We aimed to evaluate CT-related PIs diameters following 3 aspects: a cross-sectional analysis based on the age’ groups at first PI diagnosis and on the gender distribution and a longitudinal analysis in PIs with <0.5 cm versus ≥0.5 cm as the largest diameter at baseline. Methods: A retrospective, real-life, multi-centric study in adults with NF micro-PIs was performed. Results: 208 subjects (92.79% females) were included (average age 43.18 ± 12.58 y). The mean largest diameter (between transversal and longitudinal diameters) was 0.55 ± 0.16cm, and 44.71% of the PIs were located on the right part of the pituitary gland. The patients were divided into 10 age-groups (21 to 70 y), and no difference was observed between the mean largest diameters of these groups (p = 0.693). Females and males had a similar age at PIs diagnosis (p = 0.353), transverse diameter (p = 0.910), longitudinal diameter (p = 0.229), and PI location (p = 0.368). Serial CT scans (2 to 4 per patient) included a median (Q1–Q3) of 20 (12–36) months for the second CT scan, 58 (36–84) for the third CT scan, 78 (53–118) for the fourth CT scan, and a total follow-up between baseline and last CT scan of 40 (13–72) months. The initial largest diameter correlated with the diameter change between the baseline and the last CT (r = −0.575, p = 0.000). The largest PI diameter was similar between each serial CT scan (p = 0.840). According to the cut-off value of 0.5 cm diameter (for initial largest tumor diameter), group A (N = 78, 37.50%, <0.5 cm) and group B (N = 130, 62. 50%; ≥0.5 cm) had similar age at baseline (43.83 ± 12.72 versus 42.79 ± 12.54 y, p = 0.565) and PIs locations (right, left, median). The largest PI diameter remained smaller in group A versus B amid the second CT scan (p = 0.000) and the last CT scan (p = 0.009). The largest diameter change from the first to the last CT scan showed an increase in group A (median of +0.10 cm, p = 0.000) and a decrease in group B (median of −0.01 cm, p = 0.002); this diameter change was different in group A versus B (p = 0.000). The cumulative probability of tumor-growth-free survival showed different survival functions (log rank p = 0.000): group A exhibited a more gradual decrease versus B; at 60 months, the cumulative probability was 0.32 ± 0.08 for group A versus 0.75 ± 0.07 for B. During follow-up, all PIs remained NF, and no hypopituitarism was noted (as limits, we mention that dynamic hypopituitarism testing was selectively performed). Conclusions: NF micro-PIs in adults showed a similar age and sex distribution. During follow-up, PIs with a largest diameter < 0.5 cm increased after a median of 40 months but remained <1 cm, while in PIs with ≥0.5 cm, the largest diameter decreased. This highlights a lower predictability in tumor behavior than expected, particularly in larger micro-PIs that, overall, remained without relevant clinical implications after surveillance.

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Management of pituitary incidentalomas

Cited by 5 publications

References 14 publications

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

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

Clinical Impact of New Reference Intervals for the Roche Prolactin II Immunoassay

A Study in Pituitary Neuroendocrine Tumors (PitNETs): Real-Life Data Amid Baseline and Serial CT Scans

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