Pituitary Incidentaloma: An Endocrine Society Clinical Practice Guideline

Freda, Pamela U.; Beckers, Albert; Katznelson, Laurence; Molitch, Mark E.; Montori, Víctor M.; Post, Kalmon D.; Vance, Mary Lee

doi:10.1210/jc.2010-1048

Cited by 494 publications

(417 citation statements)

References 48 publications

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“…Faced with a tumor remnant after incomplete surgical resection of NFPA, the current consensus guidance for practice is expectant follow-up and the use of radiotherapy or repeat surgery if required (1,29,30). This 'wait and see' strategy reflects the often unacceptable rate of longterm complications of radiation therapy as well as the usual indolent course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists

Greenman

Cooper

Yaish

et al. 2016

European Journal of Endocrinology

118

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Objective: Clinically nonfunctioning pituitary adenoma (NFPA) remains the only pituitary tumor subtype for which no effective medical therapy is available or recommended. We evaluated dopamine agonist (DA) therapy for preventing growth of postsurgical pituitary tumor remnants. Design: The study design included historical cohort analysis of clinical results at two pituitary referral centers with different standard practices for postoperative NFPA management: DA therapy or conservative follow-up. Methods: Seventy-nine patients followed for 8.8 ± 6.5 years were treated with DA, initiated upon residual tumor detection on postoperative MRI (preventive treatment (PT) group, n = 55), or when tumor growth was subsequently detected during follow-up (remedial treatment (RT) group, n = 24). The control group (n = 60) received no medication. Tumoral dopamine and estrogen receptor expression assessed by quantitative RT-PCR and immunostaining were correlated with response to treatment. Results: Tumor mass decreased, remained stable, or enlarged, respectively, in 38, 49, and 13% of patients in the PT group, and in 0, 53, and 47% of control subjects; shrinkage or stabilization was achieved in 58% of enlarging tumors in the RT group, P < 0.0001. Fifteen-year progression-free survival rate was 0.805, 0.24, and 0.04, respectively, for PT, RT, and control groups (P < 0.001). About 42% of patients in the control group required additional surgery or radiotherapy, compared with 38 and 13% subjects in the RT and PT groups, respectively (P = 0.002). Outcome measures were not related to NFPA D2R abundance. Conclusions: Dopamine agonist therapy in patients with NFPA is associated with decreased prevalence of residual tumor enlargement after transsphenoidal surgical resection.

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Section: Discussionmentioning

confidence: 99%

Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists

Greenman

Cooper

Yaish

et al. 2016

European Journal of Endocrinology

118

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“…Overall, the prevalence of pituitary abnormalities in the paediatric population undergoing neuroimaging for reasons other than pituitary disease is lacking and data are not available on pituitary incidentalomas (33). Indeed, previous studies have reported the prevalence of ES to be about 5-9% for all ages, with an increase in prevalence with age (34,35).…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging of CNS in 15 043 children with GH deficiency in KIGS (Pfizer International Growth Database)

Maghnie

Lindberg

Kołtowska-Häggström

et al. 2013

European Journal of Endocrinology

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Objectives: Neuroimaging has become an essential part of the diagnostic process in children with GH deficiency (GHD). The aim of the study was to document the frequency of neuroanatomical abnormalities in a very large cohort of children with GHD and to relate these findings to patient clinical characteristics. Design and methods: Results of magnetic resonance imaging (MRI) were reported in 15 043 of 43 725 children with non-acquired GHD (idiopathic, neurosecretory dysfunction (NSD) and known congenital cause) who were enrolled in KIGS (Pfizer International Growth Database) between 1987 and 2011. Clinical characteristics of patients before GH treatment with normal MRI (idiopathic GHD (IGHD) and NSD) were compared with those of patients with abnormal pituitaries (hypoplasia, empty sella (ES), HME (hypoplastic anterior pituitary, missing pituitary stalk and ectopic posterior pituitary)). Results: Abnormal MRIs were found in 4032 (26.8%) children, within which ES (nZ1178 (7.8%)) and HME (nZ1019 (6.8%)) were the most frequent findings. In 2361 children diagnosed as IGHD or NSD before MRI examination, anatomical abnormalities ((pituitary hypoplasia: nZ974); (HME: nZ459)) were documented. Patients with anatomical abnormalities had more severe characteristics of GHD: normal MRI ! pituitary hypoplasia ! ES ! HME. Conclusions: GHD is associated with a great variety of neuroanatomical abnormalities as identified by MRI. The investigation and evaluation of MRI need to be conducted in a structured mode. There is an association between anatomical and functional abnormalities of the pituitary.

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“…Except for pregnant and nursing women the maximum craniocaudal diameter should not be greater than 10 mm in sagittal cross-section images [50]. Since microadenomas may be endocrine disruptors, and macroadenomas can cause compression of the optic chiasm due to their size, further endocrinological and neuro-ophthalmological investigation should be performed (Category II) even in cases of low growth tendency [50]. c Axial FLAIR image of a 22-year old fMRI-volunteer.…”

Section: Pituitary Tumorsmentioning

confidence: 99%

Management of Intracranial Incidental Findings on Brain MRI

Langner

Buelow

Fleck

et al. 2016

Fortschr Röntgenstr

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The wider use of MRI for imaging of the head in both research and clinical practice has led to an increasing number of intracranial incidental findings. Most of these findings have no immediate medical consequences. Nevertheless, knowledge of common intracranial incidental findings and their clinical relevance is necessary to adequately discuss the findings with the patient. Based on the author?s experiences from a large population-based study, the most common incidental MR findings in the brain will be presented, discussing their clinical relevance and giving recommendations for management according to the current literature and guidelines. Key points: ??Intracranial incidental findings are common. ??The majority of these findings have no immediate medical consequences. ??Knowledge of common incidental findings is necessary for appropriate management. Citation Format: ??Langner S, Buelow R, Fleck S et?al. Management of Intracranial Incidental Findings on Brain MRI. Fortschr R?ntgenstr 2016; 188: 1123???1133

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Pituitary Incidentaloma: An Endocrine Society Clinical Practice Guideline

Abstract: Practice guidelines for the endocrine evaluation and treatment of pituitary incidentalomas are presented, including indications for surgery.

Cited by 494 publications

References 48 publications

Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists

Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists

Magnetic resonance imaging of CNS in 15 043 children with GH deficiency in KIGS (Pfizer International Growth Database)

Management of Intracranial Incidental Findings on Brain MRI

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