Match!

Pituitary tumours: pituitary incidentalomas.

Published on Oct 1, 2009in Best Practice & Research Clinical Endocrinology & Metabolism3.808
· DOI :10.1016/j.beem.2009.05.001
Molitch Me1
Estimated H-index: 1
Abstract
: Clinically non-functioning pituitary adenomas range from being completely asymptomatic, and therefore being detected either at autopsy or as incidental findings on head magnetic resonance imaging (MRI) or computed tomography (CT) scans performed for other reasons (often referred to as 'pituitary incidentalomas'), to causing significant hypothalamic/pituitary dysfunction and visual field compromise due to their large size. Patients with pituitary incidentalomas should all be screened for hypersecretion (prolactin (PRL), IGF-1, midnight salivary cortisol), and those with macroadenomas should also be screened for hypopituitarism (macroadenomas) and for visual field defects if the tumour abuts the optic chiasm. Growth of non-functioning pituitary adenomas without treatment occurs in about 10% of microadenomas and 24% of macroadenomas. In the absence of hypersecretion, hypopituitarism or visual field defects, patients may be followed up by periodic screening by MRI for enlargement. Growth of a pituitary incidentaloma is an indication for surgery.
  • References (57)
  • Citations (76)
📖 Papers frequently viewed together
219 Citations
461 Citations
576 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References57
Newest
#1Olaf M. Dekkers (LUMC: Leiden University Medical Center)H-Index: 57
#2Alberto M. Pereira (LUMC: Leiden University Medical Center)H-Index: 55
Last. Johannes A. Romijn (LUMC: Leiden University Medical Center)H-Index: 83
view all 3 authors...
Context: Although the majority of pituitary macroadenomas are clinically nonfunctioning, treatments as well as follow-up strategy for this condition lack evidence from randomized studies. Evidence Acquisition: We evaluated the evidence of treatment and follow-up strategies for clinically nonfunctioning adenomas. PubMed was searched for articles on nonfunctioning adenomas in November 2007, and references of selected articles were assessed for potentially relevant articles. Evidence Synthesis: All...
139 CitationsSource
#1Kevin C. J. Yuen (OHSU: Oregon Health & Science University)H-Index: 22
#2David M. Cook (OHSU: Oregon Health & Science University)H-Index: 32
Last. Theodore C. Friedman (Charles R. Drew University of Medicine and Science)H-Index: 40
view all 7 authors...
Summary Objective GH is usually the first pituitary hormone to be affected following a pathological insult to the pituitary; however, data on the prevalence of GH deficiency in patients with nonsecreting pituitary microadenomas and normal serum IGF-1 levels are scarce. This study aims to evaluate the prevalence of GH and other anterior pituitary hormone deficiencies, and to determine whether microadenomas per se could be associated with reduced GH response rates to GHRH–arginine stimulation. Des...
27 CitationsSource
Clinically nonfunctioning adenomas (CNFAs) range from being completely asymptomatic, and therefore detected at autopsy or as incidental findings on head MRI or CT scans performed for other reasons, to causing significant hypothalamic/pituitary dysfunction and visual field compromise because of their large size. Patients with incidental adenomas should be screened for hypersecretion and hyposecretion. In the absence of hypersecretion, hypopituitarism, or visual field defects, patients may be foll...
83 CitationsSource
#1Juergen Honegger (University of Tübingen)H-Index: 16
#2Sanna ZimmermannH-Index: 1
Last. Klaus DietzH-Index: 64
view all 8 authors...
Objective: Recent observational studies have established progression and recurrence rates of pituitary adenomas. However, it is still unknown how individual pituitary adenomas grow over years and whether growth kinetics follow a distinct growth model. The objective of this study was to define a growth model for non-functioning pituitary adenomas. Methods: Fifteen patients who had five or more serial high-quality examinations with magnetic resonance images or computerized tomography scans were id...
36 CitationsSource
#1Niki Karavitaki (Churchill Hospital)H-Index: 33
#2K. Collison (Churchill Hospital)H-Index: 1
Last. Jah Wass (Churchill Hospital)H-Index: 1
view all 7 authors...
Summary Background Series of patients systematically investigating the outcome of clinically nonfunctioning pituitary adenomas (NFAs) not treated by surgery or radiotherapy during long follow-up periods are limited. Most reports involve the follow-up of selected cases of incidentally found lesions, rendering their results unreliable on the assessment of the pros and cons of a ‘watch and wait’ policy. Objective To investigate the outcome of a series of consecutive patients with presumed NFA (micr...
94 CitationsSource
#1Adrian Daly (University of Liège)H-Index: 36
#2Maria Cristina Burlacu (University of Liège)H-Index: 7
Last. Albert Beckers (University of Liège)H-Index: 55
view all 4 authors...
Prevalence: The prevalence of pituitary tumors has been a topic of controversy for many years. Autopsy and radiological series show that pituitary incidentalomas may be present in on
33 CitationsSource
#1Meike W. VernooijH-Index: 55
#2M. Arfan Ikram (EUR: Erasmus University Rotterdam)H-Index: 86
Last. A. van der LugtH-Index: 70
view all 9 authors...
Background Magnetic resonance imaging (MRI) of the brain is increasingly used both in research and in clinical medicine, and scanner hardware and MRI sequences are continually being improved. These advances are likely to result in the detection of unexpected, asymptomatic brain abnormalities, such as brain tumors, aneurysms, and subclinical vascular pathologic changes. We conducted a study to determine the prevalence of such incidental brain findings in the general population. Methods The subjec...
864 CitationsSource
#1Jang-Hee Kim (Ajou University)H-Index: 21
#2Jung Seok SeoH-Index: 1
Last. Kyi-Beom Lee (Ajou University)H-Index: 2
view all 6 authors...
To investigate the characteristics of incidental pituitary microadenomas, we examined 120 pituitary glands from Korean forensic autopsy cases, from which eight tumors were identified (incidence 6.7%). The average age of the affected subjects was 50 yr (range: 33-96 yr) with a female predominance. The maximum diameters of the tumors ranged from 0.4 to 5.4 mm (mean: 2.8 mm). Immunohistochemical analysis of pituitary hormones revealed three growth hormone-secreting adenomas, one prolactin-producing...
12 CitationsSource
#1Olaf M. Dekkers (LUMC: Leiden University Medical Center)H-Index: 57
#2Sebastiaan Hammer (LUMC: Leiden University Medical Center)H-Index: 16
Last. Alberto M. Pereira (LUMC: Leiden University Medical Center)H-Index: 55
view all 8 authors...
Objective: The natural history of non-functioning pituitary macroadenomas (NFMA) has not been completely elucidated. Therefore, we evaluated pituitary function, visual fields, and tumor size during long-term follow-up of non-operated patients with NFMA. Design: Follow-up study. Patients: Twenty-eight patients (age 55G3 years) with NFMA, not operated after initial diagnosis, were included. Results: Initial presentation was pituitary insufficiency in 44%, visual field defects in 14%, apoplexy in 1...
117 CitationsSource
#1Marion Rittierodt (Hochschule Hannover)H-Index: 1
#2Akira HoriH-Index: 9
The clinically silent premorbid conditions of the pituitary, in particular preneoplastic features, were morphologically and statistically investigated within a control population at autopsy. A higher percentage of premorbid states were found, which was speculated to be a basis of possible later clinical lesions. They were as follows in 228 pituitary specimens: incidentalomas in 3% (potential pituitary adenomas), aberrant salivary gland cell clusters in the pars intermedia in 8.8% (potential sali...
8 CitationsSource
Cited By76
Newest
Source
#1Chenglong Cao (Southern Medical University)H-Index: 2
#2Jian SongH-Index: 4
Last. Guozheng Xu (Southern Medical University)H-Index: 6
view all 9 authors...
Objectives:Injured cognitive abilities have been reported in patients with pituitary adenoma. However, to date, few researchers have directly investigated the electrophysiological study of inhibito...
Source
#1Amit Mahajan (Yale University)H-Index: 13
#2Richard A. Bronen (Yale University)H-Index: 36
Last. Silvio E. Inzucchi (Yale University)H-Index: 77
view all 6 authors...
Magnetic resonance (MR) imaging is an essential tool in the diagnosis and management of pituitary diseases, indispensable for making correct treatment decisions. Successful management and follow-up of pituitary pathology requires an understanding of the MR appearance of normal and abnormal structures in the sellar region. This review will describe the MR appearance of the normal and abnormal pituitary gland and proposes an algorithm for the management strategy of some of the most common abnormal...
1 CitationsSource
#1Mina M. Gerges (Ain Shams University)H-Index: 1
#2Kavelin Rumalla (UMKC: University of Missouri–Kansas City)H-Index: 8
Last. Theodore H. SchwartzH-Index: 60
view all 10 authors...
OBJECTIVE: Nonfunctioning pituitary adenomas are benign, slow-growing tumors. After gross-total resection (GTR) or subtotal resection (STR), tumors can recur or progress and may ultimately require additional intervention. A greater understanding of long-term recurrence and progression rates following complete or partial resection and the need for further intervention will help clinicians provide meaningful counsel for their patients and assist data-driven decision-making. METHODS: The authors re...
Source
Pituitary tumors (PTs) are a heterogeneous group of lesions of the central nervous system that are usually benign. Most of them occur sporadically, but 5% can do so within family syndromes, usually at a young age. There are differences by sex, age, race, and genetic factors in the prevalence of different tumor cell types and clinical presentation. Functioning-PTs (FPTs) are usually diagnosed earlier than non-functioning PTs (NFPTs). However, this depends on the PT type. Headaches and visual dist...
Source
#1Vidhu V. Thaker (Boston Children's Hospital)H-Index: 9
#2Adrianne E Lage (Wellesley College)H-Index: 1
Last. Laurie E. Cohen (Harvard University)H-Index: 26
view all 5 authors...
CONTEXT: Pituitary lesions consistent with microadenomas are increasingly discovered by MRI. Sparse data are available on the long-term clinical and imaging course of such lesions in children. OBJECTIVE: The aim of this study was to define the clinical and imaging course of pituitary lesions representing or possibly representing nonfunctioning microadenomas in children to guide clinical management. DESIGN: Retrospective observational study. METHODS: The clinical data warehouse at a tertiary care...
1 CitationsSource
#1Jorianne BoersH-Index: 1
Last. Mark J. C. van Treijen (UU: Utrecht University)H-Index: 2
view all 4 authors...
In this case report, we highlight four different cases of ectopic adrenocorticotropic hormone (ACTH) secretion with different pitfalls in the diagnostic workup. Ectopic ACTH secretion (EAS) is an uncommon cause of Cushing’s syndrome that accompanies a variety of tumours. It is associated with significant morbidity and mortality. This underlines the importance of early and adequate diagnosis. We will review the causes of EAS and their presentation to increase awareness of this rare and progressiv...
Source
#1Daniela Esposito (Sahlgrenska University Hospital)H-Index: 11
#2Daniel S Olsson (Sahlgrenska University Hospital)H-Index: 11
Last. Gudmundur Johannsson (Sahlgrenska University Hospital)H-Index: 53
view all 6 authors...
Purpose Non-functioning pituitary adenomas (NFPAs) are associated with impaired well-being, increased comorbidities, and reduced long-term survival. Data on optimal management of NFPAs around surgical treatment are scarce, and postoperative treatment and follow-up strategies have not been evaluated in prospective trials. Here, we review the preoperative, perioperative, and early postoperative management of patients with NFPAs.
Source
#1Justin Seltzer (SC: University of Southern California)H-Index: 4
#2Michelle A. Wedemeyer (SC: University of Southern California)H-Index: 3
Last. Gabriel Zada (SC: University of Southern California)H-Index: 33
view all 6 authors...
OBJECTIVEIncidental pituitary adenomas (IPAs) are commonly discovered during cranial imaging evaluations obtained for unrelated indications. The optimal management of IPA remains controversial. The authors investigated the outcomes and safety of the surgical treatment of IPAs at their institution.METHODSClinical outcome data for 1692 patients surgically treated for pituitary adenomas at the Keck Medical Center of USC/USC Pituitary Center over a 17-year period (1999–2016) were reviewed to identif...
2 CitationsSource
#1Cesar Luiz Boguszewski (UFPR: Federal University of Paraná)H-Index: 24
#2Nina R. C. Musolino (USP: University of São Paulo)H-Index: 16
Last. Leandro Kasuki (UFRJ: Federal University of Rio de Janeiro)H-Index: 15
view all 3 authors...
Pituitary incidentalomas (PIs) represent a modern clinical entity increasingly recognized due to advances and easier accessibility to imaging techniques. By definition, PIs should be detected during brain imaging performed for investigation of a non-pituitary disease. Although anatomic variations, technical artefacts or pituitary hyperplasia might also be interpreted as PIs, the most relevant incidentally detected lesions are those that fulfill radiological criteria for a pituitary adenoma in as...
Source