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pituitary incidentaloma
incidentally discovered pituitary adenoma by CT or MRI. (see pituitary adenoma)
Etiology:
- most are benign, nonfunctional pituitary adenoma Epidemiolgy:
- at least 10% of adults have pituitary microadenomas, most often incidental findings of brain MRI
- median microadenoma size is 4 mm
- size remains unchanged in 44% of patients, increases in 28%, decreases in 19%, & increases but later decreases in 9% over the 5 years after discovery
- only 3 of 177 microadenomas increased in size to > 10 mm [3]
Laboratory:
- serum prolactin
- serum IGF-1
- serum cortisol (AM)
may be optional
- ADH (serum sodium, serum osmolality, urine sodium, urine osmolality)
- serum TSH with reflex free T4
- serum LH serum FSH, 8 AM serum testosterone (male) serum estradiol (female)
Radiology:
- pituitary incidentaloma identified by CT or MRI of sella turcica
Differential diagnosis:
- acromegaly
- Cushing's syndrome
- prolactinoma
Management:
- evaluate for hypopituitarism
- treat underlying disorder
- neurosurgery consultation
a) visual field defects
b) oculomotor nerve palsies
c) optic chiasm compression
d) hormone hypersecretion
e) hypopituitarism
f) tumor growth [1]
General
incidentaloma
pituitary adenoma
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 19
American College of Physicians, Philadelphia 2012, 2022
- Freda PU, Beckers AM, Katznelson L et al
Pituitary incidentaloma: an endocrine society clinical practice
guideline.
J Clin Endocrinol Metab. 2011 Apr;96(4):894-904
PMID: 21474686
- Hordejuk D et al.
Long-term changes in the size of pituitary microadenomas.
Ann Intern Med 2023 Feb 28; [e-pub].
PMID: 36848656
https://www.acpjournals.org/doi/10.7326/M22-1728