Pituitary incidentalomas: analysis of a neuroradiological cohort

Esteves, César A.; Neves, Celestino; Augusto, Luís; Menezes, Joana; Pereira, Josué; Bernardes, Irene; Fonseca, J.; Carvalho, Davide

doi:10.1007/s11102-015-0652-7

Cited by 39 publications

(22 citation statements)

References 16 publications

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“…In this paper, our stricter inclusion criteria, our large cohort with a long follow-up allowed us to bet- ter define some of the characteristics of the most common type of PIs. CNPIs in our cohort were more commonly diagnosed during the fifth decade and in female patients, similarly to other studies [4,6,7]. While micro and macroadenomas were almost equally represented, we found a significant difference in tumor size between genders, with men more likely to have a macroadenoma.…”

Section: Discussionsupporting

confidence: 89%

“…The association of headache and pituitary masses is controversial [13], and we therefore decided to include only those patients in whom headache was judged not to be associated with the presence of the adenoma. This probably accounts for the lower figures for headache as an indication for imaging in our cohort compared to the one reported in other studies (11.9% vs. around 30% in published papers) [2,7]. While this might have led us to exclude some patients in which headache was not caused by the sellar mass, this have allowed us to be more confident that we have included only patients with an incidental imaging finding, that is, true PIs.…”

Section: Discussionmentioning

confidence: 72%

“…In our cohort, the most common indication for imaging was neuroophthalmological/ear, nose and throat problems; this is different from what described by other groups, which found headache as the most common indication for brain imaging leading to the diagnosis of PIs [2,6,7]. The association of headache and pituitary masses is controversial [13], and we therefore decided to include only those patients in whom headache was judged not to be associated with the presence of the adenoma.…”

Section: Discussionmentioning

confidence: 73%

“…No study has specifically focused clinically nonfunctioning PIs (CNFPIs). Moreover, although secondary hormonal deficiencies (SHD) are frequently described in these patients (13-46% of cases) [5][6][7], little is known regarding their risk factors at diagnosis and during follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

et al. 2019

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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-

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

et al. 2019

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“…Possible explanations of this trend may be that most PI were detected on MRI and CT scans of the brain rather than that of the sella which may have missed smaller lesions. There is also a possibility that the radiologists may have under-reported small lesions, since another recent study reported a slightly higher proportion (37.5%) of microadenomas (15).…”

Section: Discussionmentioning

confidence: 99%

Analysis and natural history of pituitary incidentalomas

Imran

Yip

Papneja

et al. 2016

European Journal of Endocrinology

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Objectives: Pituitary incidentalomas (PI) are frequently found on brain imaging. Despite their high prevalence, little is known about their long-term natural history and there are limited guidelines on how to monitor them. Methods: We conducted a retrospective study to compare epidemiological characteristics at presentation and the natural history of PI in population-based vs referral-based registries from two tertiary-care referral centers in Canada. Results: A total of 328 patients with PI were included, of whom 73% had pituitary adenomas (PA) and 27% had non-pituitary sellar masses. The commonest indications for imaging were headache (28%), dizziness (12%) and stroke/transient ischemic attack (TIA) (9%). There was a slight female preponderance (52%) with a median age of 55 years at diagnosis; 71% presented as macroadenomas (>10 mm). Of PA, 25% were functioning tumors and at presentation 36% of patients had evidence of secondary hormonal deficiency (SHD). Of the total cohort, 68% were treated medically or conservatively whereas 32% required surgery. Most tumors (87% in non-surgery and 68% in post-surgery group) remained stable during follow-up. Similarly, 84% of patients in the non-surgery and 73% in the surgery group did not develop additional SHD during follow-up. The diagnosis of non-functioning adenoma was a risk factor for tumor enlargement and a change in SHD status was associated with a change in tumor size. Conclusions: Our data suggest that most PI seen in tertiary-care referral centers present as macroadenomas and may frequently be functional, often requiring medical or surgical intervention.

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Case 32

Kidd¹

2017

Neuro-Ophthalmology

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Pituitary incidentalomas: analysis of a neuroradiological cohort

Abstract: In concordance with available literature, adenomas are the most frequent incidentally found pituitary lesions. Hormonal dysfunction is quite prevalent, including symptomatic presentations, which suggests that there seems to be a low sensitivity for the diagnosis of pituitary disease.

Cited by 39 publications

References 16 publications

Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

Clinically Nonfunctioning Pituitary Incidentalomas: Characteristics and Natural History

Analysis and natural history of pituitary incidentalomas

Case 32

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