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      Pituitary Incidentaloma: An Endocrine Society Clinical Practice Guideline

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          Abstract

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

          Abstract

          Objective:

          The aim was to formulate practice guidelines for endocrine evaluation and treatment of pituitary incidentalomas.

          Consensus Process:

          Consensus was guided by systematic reviews of evidence and discussions through a series of conference calls and e-mails and one in-person meeting.

          Conclusions:

          We recommend that patients with a pituitary incidentaloma undergo a complete history and physical examination, laboratory evaluations screening for hormone hypersecretion and for hypopituitarism, and a visual field examination if the lesion abuts the optic nerves or chiasm. We recommend that patients with incidentalomas not meeting criteria for surgical removal be followed with clinical assessments, neuroimaging (magnetic resonance imaging at 6 months for macroincidentalomas, 1 yr for a microincidentaloma, and thereafter progressively less frequently if unchanged in size), visual field examinations for incidentalomas that abut or compress the optic nerve and chiasm (6 months and yearly), and endocrine testing for macroincidentalomas (6 months and yearly) after the initial evaluations. We recommend that patients with a pituitary incidentaloma be referred for surgery if they have a visual field deficit; signs of compression by the tumor leading to other visual abnormalities, such as ophthalmoplegia, or neurological compromise due to compression by the lesion; a lesion abutting the optic nerves or chiasm; pituitary apoplexy with visual disturbance; or if the incidentaloma is a hypersecreting tumor other than a prolactinoma.

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          Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK).

          Alberto Fernandez, Niki Karavitaki, John Wass (2010)
          Pituitary adenomas (PAs) are associated with increased morbidity and mortality. The optimal delivery of services and the provision of care for patients with PAs require distribution of the resources proportionate to the impact of these conditions on the community. Currently, the resource allocation for PAs in the health care system is lacking a reliable and an up-to-date epidemiological background that would reflect the recent advances in the diagnostic technologies, leading to the earlier recognition of these tumours. To determine the prevalence, the diagnostic delay and the characteristics of patients with PA in a well-defined geographical area of the UK (Banbury, Oxfordshire). Sixteen general practitioner (GP) surgeries covering the area of Banbury and a total population of 89 334 inhabitants were asked to participate in the study (data confirmed on 31 July 2006). Fourteen surgeries with a total of 81,449 inhabitants (91% of the study population) agreed to take part. All cases of PAs were found following an exhaustive computer database search of agreed terms by the staff of each Practice and data on age, gender, presenting manifestations and their duration, imaging features at diagnosis, history of multiple endocrine neoplasia type 1 and family history of PA were collected. A total of 63 patients with PA were identified amongst the study population of 81,149, with a prevalence of 77.6 PA cases/100,000 inhabitants (prolactinomas; PRLoma: 44.4, nonfunctioning PAs: 22.2, acromegaly; ACRO: 8.6, corticotroph adenoma: 1.2 and unknown functional status; UFS: 1.2/100,000 inhabitants). The distribution of each PA subtype was for PRLoma 57%, nonfunctioning PAs 28%, ACRO 11%, corticotroph adenoma 2% and UFS 2%. The median age at diagnosis and the duration of symptoms until diagnosis (in years) were for PRLoma 32.0 and 1.5, nonfunctioning PAs 51.5 and 0.8, ACRO 47 and 4.5 and corticotroph adenoma 57 and 7, respectively. PRLoma was the most frequent PA diagnosed up to the age of 60 years (0-20 years: 75% and 20-60 years: 61% of PAs) and nonfunctioning PA after the age of 60 years (60% of PAs). Nonfunctioning PAs dominated in men (57% of all men with PA) and PRLoma in women (76% of all women with PA). Five patients (7.9%) presented with classical pituitary apoplexy, with a prevalence of 6.2 cases/100,000 inhabitants. Based on a well-defined population in Banbury (Oxfordshire, UK), we have shown that PAs have a fourfold increased prevalence than previously thought; our data confirm that PAs have a higher burden on the Health Care System and optimal resource distribution for both clinical care and research activities aiming to improve the outcome of these patients are needed.
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            High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium.

            Adrian F. Daly, Martine Rixhon, Christelle Adam … (2006)
            Prevalence data are important for assessing the burden of disease on the health care system; data on pituitary adenoma prevalence are very scarce. The objective of the study was to measure the prevalence of clinically relevant pituitary adenomas in a well-defined population. This was a cross-sectional, intensive, case-finding study performed in three regions of the province of Liège, Belgium, to measure pituitary adenoma prevalence as of September 30, 2005. The study was conducted in specialist and general medical practitioner patient populations, referral hospitals, and investigational centers. Three demographically and geographically distinct districts of the province of Liège were delineated precisely using postal codes. Medical practitioners in these districts were recruited, and patients with pituitary adenomas under their care were identified. Diagnoses were confirmed after retrieval of clinical, hormonal, radiological, and pathological data; full demographic and therapeutic follow-up data were collected in all cases. Sixty-eight patients with clinically relevant pituitary adenomas were identified in a population of 71,972 individuals; the mean (+/- sd) prevalence was 94 +/- 19.3 cases per 100,000 population (95% confidence interval, 72.2 to 115.8). The group was 67.6% female and had a mean age at diagnosis of 40.3 yr; 42.6% had macroadenomas and 55.9% underwent surgery. Prolactinomas comprised 66% of the group, with the rest having nonsecreting tumors (14.7%), somatotropinomas (13.2%), or Cushing's disease (5.9%); 20.6% had hypopituitarism. The prevalence of pituitary adenomas in the study population (one case in 1064 individuals) was more than 3.5-5 times that previously reported. This increased prevalence may have important implications when prioritizing funding for research and treatment of pituitary adenomas.
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              Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas.

              David Kleinberg, M F Scanlon, Marcello D. Bronstein … (2006)
              In June 2005, an ad hoc Expert Committee formed by the Pituitary Society convened during the 9th International Pituitary Congress in San Diego, California. Members of this committee consisted of invited international experts in the field, and included endocrinologists and neurosurgeons with recognized expertise in the management of prolactinomas. Discussions were held that included all interested participants to the Congress and resulted in formulation of these guidelines, which represent the current recommendations on the diagnosis and management of prolactinomas based upon comprehensive analysis and synthesis of all available data.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Endocrinol Metab
                Journal ID (iso-abbrev): J. Clin. Endocrinol. Metab
                Journal ID (publisher-id): jcem
                Journal ID (publisher-id): jceme
                Journal ID (pmc): jcem
                Title: The Journal of Clinical Endocrinology and Metabolism
                Publisher: Endocrine Society (Chevy Chase, MD )
                ISSN (Print): 0021-972X
                ISSN (Electronic): 1945-7197
                Publication date (Print): April 1, 2011
                Volume: 96
                Issue: 4
                Pages: 894-904
                Affiliations
                Columbia College of Physicians & Surgeons (P.U.F.), New York, New York 10032; Centre Hospitalier Universitaire de Liège (A.M.B.), University of Liège Domaine Universitaire du Sart-Tilman, 4020 Liège, Belgium; Stanford University (L.K.) Stanford, California 94305; Northwestern University Feinberg School of Medicine (M.E.M.) Chicago, Illinois 60611; Mayo Clinic Rochester (V.M.M.), Rochester, Minnesota 55905; Mount Sinai Medical Center (K.D.P.) New York, New York 10029; and University of Virginia Health Science Center (M.L.V.) Charlottesville, Virginia 22903
                Author notes
                Address all correspondence and requests for reprints to: The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, MD 20815. E-mail: govt-prof@ 123456endo-society.org , Telephone: 301-941-0200. Address all commercial reprint requests for orders 101 and more to: Walchli Tauber Group Inc., E-mail: Karen.burkhardt@ 123456wt-group.com . Address all reprint requests for orders for 100 or fewer to Society Services, Telephone: 301-941-0210, E-mail: societyservices@ 123456endo-society.org , or Fax: 301-941-0257.
                Article
                Publisher ID: 10-1048
                DOI: 10.1210/jc.2010-1048
                PMC ID: 5393422
                PubMed ID: 21474686
                SO-VID: 26d16182-2315-42bc-b233-40d3ceadcf5b
                Copyright © © 2011 by The Endocrine Society
                License:

                This article is published under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (CC-BY-NC-ND; http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 6 May 2010
                Date accepted : 7 December 2010
                Related
                Categories
                Compound subject: ER, Emergency Radiology
                Compound subject: HP, Health Policy
                Subject: Special Features - Clinical Practice Guideline
                Subject: Special Features

                ScienceOpen disciplines: Endocrinology & Diabetes
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes

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