Pituitary Incidentalomas

  • Mark E. Molitch
Part of the Endocrine Updates book series (ENDO, volume 7)


The routine use of the high resolution methods of imaging of magnetic resonance imaging (MRI) and computed tomography (CT) for most central nervous system (CNS) diseases has created the dilemma for the clinician of the radiologist being able to detect asymptomatic masses in the pituitary, referred to as “pituitary incidentalomas” (5–7,14,21,38,45,48,60,66). It is the purpose of this chapter to provide information and guidelines for the evaluation of the patient incidentally found to have a mass lesion of the pituitary on a CT or MRI scan that has been performed for some other reason (Figure 1).


Pituitary Adenoma Pituitary Gland Pituitary Apoplexy Gonadotroph Adenoma Secreting Adenoma 
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  1. 1.
    Serri O, Marchisio AM, Collu R, Hardy J, Somma M. Dopaminergic binding sites in human pituitary adenomas other than prolactinomas. Horm Res. 1984;19:97.PubMedCrossRefGoogle Scholar
  2. 2.
    Bevan JS, Burke CW. Non-functioning pituitary adenomas do not regress during bromocriptine therapy but possess membrane-bound dopamine receptors which bind bromocriptine. Clin Endocrinol. 1986;25:561.CrossRefGoogle Scholar
  3. 3.
    Asa SL. The pathology of pituitary tumors. Endocrinol Metab Clin North Am. 1999;28:XX.Google Scholar
  4. 2.
    Auer RN, Alakija P, Sutherland GR. Asymptomatic large pituitary adenomas discovered at autopsy. Surg Neurol. 1996;46:28.PubMedCrossRefGoogle Scholar
  5. 3.
    Bates AS, Van’t Hoff W, Jones PJ, et al. The effect of hypopituitarism on life expectancy. J Clin Endocrinol Metab. 1996;81:1169.PubMedCrossRefGoogle Scholar
  6. 4.
    Burrows GN, Wortzman G, Rewcastle NB, et al. Microadenomas of the pituitary and abnormal sellar tomograms in an unselected autopsy series. N Engl J Med. 1981;304:156.CrossRefGoogle Scholar
  7. 5.
    Chacko AG, Chandy MJ. Incidental pituitary macroadenomas. Brit J Neurosurg. 1992;6:233.CrossRefGoogle Scholar
  8. 6.
    Chambers EF, Turski PA, LaMasters D, et al. Regions of low density in the contrast-enhanced pituitary gland: normal and pathologic processes. Radiology 1982;44:109..Google Scholar
  9. 7.
    Chong BW, Kucharczyk AW, Singer W, et al. Pituitary gland MR: a comparative study of healthy volunteers and patients with microadenomas. Am J Neuroradiol 1994; 15:675.PubMedGoogle Scholar
  10. 8.
    Conway BJ, McCrohan JL, Antonsen RG, et al. Average radiation dose in standard CT examinations of the head: results of the 1990 NEXT Survey. Radiology 1992;184:135.PubMedGoogle Scholar
  11. 9.
    Costello RT. Subclinical adenoma of the pituitary gland. Am J Pathol. 1936;12:205.PubMedGoogle Scholar
  12. 10.
    Coulon G, Fellmann D, Arbez-Gindre F, et al. Les adenome hypophysares latents. Etude autopsique. Sem Hop Paris. 1983;59:2747.Google Scholar
  13. 11.
    de Herder WW, van der Lely AJ, Janssen JAMJL et al. IGFBP-3 is a poor parameter for assessment of clinical activity in acromegaly. Clin Endocrinol. 1995;43:501.CrossRefGoogle Scholar
  14. 12.
    Dombrowski RC, Romeo JH, Aron DC. Verapamil-induced hyperprolactinemia complicated by a pituitary incidentaloma. Ann Pharmacother. 1995;29:999.PubMedGoogle Scholar
  15. 13.
    Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: Specificity of imaging features. Am J Roentgenol. 1996;167:597.Google Scholar
  16. 14.
    Donovan LE, Corenblum B. The natural history of the pituitary incidentaloma. Arch Intern Med. 1995;153:181.CrossRefGoogle Scholar
  17. 15.
    El-Hamid MWA, Joplin GF, Lewis PD. Incidentally found small pituitary adenomas may have no effect on fertility. Acta Endocrinol. 1998;117:361.Google Scholar
  18. 16.
    Elster AD. Modern imaging of the pituitary. Radiology 1993;187:1.PubMedGoogle Scholar
  19. 17.
    Elster AD, Chen MYM, Williams DW III, et al. Pituitary gland: MR imaging of physiologic hypertrophy in adolescence. Radiology 1990;174:681.PubMedGoogle Scholar
  20. 18.
    Elster AD, Sanders TG, Vines FS, et al. Size and shape of the pituitary gland during pregnancy and post partum: measurement with MR imaging. Radiology 1991; 81:531.Google Scholar
  21. 19.
    Feldkamp J, Becker A, Santen R, Seppel T, Schlaghecke R. Incidentalomas of the pituitary gland. Eur J Endocrinol. 1994;130(Suppl. 2):144.Google Scholar
  22. 20.
    Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am. 1999;28:XX.Google Scholar
  23. 21.
    Hall WA, Luciano MG, Doppman JL, et al. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med. 1994;120:817.PubMedGoogle Scholar
  24. 22.
    Johnson MR, Hoare RD, Cox T, et al. The evaluation of patients with a suspected pituitary microadenoma: computed tomography compared to magnetic resonance imaging. Clin Endocrinol. 1992;36:335.CrossRefGoogle Scholar
  25. 23.
    King JT Jr, Justice AC, Aron DC. Management of incidental pituitary microadenomas: a cost-effectiveness analysis. J Clin Endocrinol Metab. 1997;82:3625.PubMedCrossRefGoogle Scholar
  26. 24.
    Koppelman MCS, Jaffe MJ, Rieth KG, et al. Hyperprolactinemia, amenorrhea, and galactorrhea. Ann Intern Med 1984;100:115.PubMedGoogle Scholar
  27. 25.
    Kovacs K, Ryan N, Horvath E. Pituitary adenomas in old age. J Gerontol. 1980;35:16.PubMedGoogle Scholar
  28. 26.
    Krishnan KRR, Doraiswamy PM, Lurie SN, et al. Pituitary size in depression. J Clin Endocrinol Metab. 1991;72:256.PubMedCrossRefGoogle Scholar
  29. 27.
    Lamberts SW, de Herder WW, van der Lely AJ. Pituitary insufficiency. Lancet 1998;352:127.PubMedGoogle Scholar
  30. 28.
    Landolt AM. Biology of pituitary microadenomas. In: Faglia G, Giovanelli MA, MacLeod RM, eds. Pituitary Microadenomas. New York: Academic Press; 1980, p.107.Google Scholar
  31. 29.
    March CM, Kletzky OA, Davajan V, et al. Longitudinal evaluation of patients with untreated prolactin-secreting pituitary adenomas. Am J Obstet Gynecol. 1981; 39:835.Google Scholar
  32. 30.
    Marin F, Kovacs KT, Scheithauer BW, et al. The pituitary gland in patients with breast carcinoma: a histologic and immunocytochemical study of 125 cases. Mayo Clin Proc.1992;67:949.PubMedGoogle Scholar
  33. 31.
    Marcovitz S, Wee R, Chan J, et al. The diagnostic accuracy of preoperative CT scanning in the evaluation of pituitary ACTH-secreting adenomas. Am J Radiol. 1987;149:803.Google Scholar
  34. 32.
    Marcovitz S, Wee R, Chan J, et al. Diagnostic accuracy of preoperative CT scanning of pituitary prolactinomas. Am J Neuroradiol. 1988;9:13.PubMedGoogle Scholar
  35. 33.
    Marcovitz S, Wee R, Chan J, et al. Diagnostic accuracy of preoperative CT scanning of pituitary somatotroph adenomas. Am J Neuroradiol. 1988;9:19.PubMedGoogle Scholar
  36. 34.
    McCormick WF, Halmi NS. Absence of chromophobe adenomas from a large series of pituitary tumors. Arch Pathol 1971;92:231.PubMedGoogle Scholar
  37. 35.
    Melmed S. Acromegaly. N Engl J Med.1990;322:966.PubMedCrossRefGoogle Scholar
  38. 36.
    Molitch ME. Diagnosis and treatment of prolactinomas. Adv Intern Med 1999;44:117.PubMedGoogle Scholar
  39. 37.
    Molitch ME, Reichlin S. Hypothalamic hyperprolactinemia: Neuroendocrine regulation of prolactin secretion in patients with lesions of the hypothalamus and pituitary stalk. In: MacLeod RM, Thorner MO, Scapagnini U, eds., Prolactin. Basic and Clinical Correlates. Proceedings of the IVth International Congress on Prolactin, Padova, Italy, Liviana Press, 1985, p. 709.Google Scholar
  40. 38.
    Molitch ME, Russell EJ. The pituitary incidentaloma. Ann Intern Med. 1990;112:925.PubMedGoogle Scholar
  41. 39.
    Mosca L, Costanzi G, Anotonacci C, et al. Hypophyseal pathology in AIDS. Histol Histopathol. 1992;7:291.PubMedGoogle Scholar
  42. 40.
    Mosca L, Solcia E, Capella C, et al. Pituitary adenomas: surgical versus post-mortem findings today. In: Faglia G, Giovanelli MA, MacLeod RM, eds. Pituitary Microadenomas. New York: Academic Press; 1980, p.137.Google Scholar
  43. 41.
    Muhr C, Bergstrom K, Grimelius L, et al. A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens. Neuroradiology 1981;21:55.PubMedCrossRefGoogle Scholar
  44. 42.
    Naidich MJ, Russell EJ. Current approaches to imaging of the sellar region and pituitary. Endocrinol Metab Clin North Am. 1999;28:XX.Google Scholar
  45. 43.
    Parent AD, Bebin J, Smith RR. Incidental pituitary adenomas. J Neurosurg. 1981;54:228.PubMedCrossRefGoogle Scholar
  46. 44.
    Peck WW, Dillon WP, Norman D, et al. High-resolution MR imaging of microadenomas at 1.5 T: experience with Cushing disease. Am J Neuroradiol. 1988;9:1085.Google Scholar
  47. 45.
    Peyster RG, Adler LP, Viscarello RR, et al. CT of the normal pituitary gland. Neuroradiology 1986;28:161.PubMedCrossRefGoogle Scholar
  48. 46.
    Powrie JK, Powell M, Ayers AB, et al. Lymphocytic adenohypophysitis: magnetic resonance imaging features of two new cases and a review of the literature. Clin Endocrinol. 1995;42:315.CrossRefGoogle Scholar
  49. 47.
    Raff H, Findling J. Current approaches to the diagnosis of Cushing’s disease. Endocrinol Metab Clin North Am. 1999;28:XX.Google Scholar
  50. 48.
    Reincke M, Allolio B, Saeger W, et al. The ‘incidentaloma’ of the pituitary gland. Is neurosurgery required? JAMA. 1990;263:2772.Google Scholar
  51. 49.
    Sano T, Kovacs KT, Scheithauer BW, et al. Aging and the human pituitary gland. Mayo Clin Proc. 1993;68:971.PubMedGoogle Scholar
  52. 50.
    Saris SC, Patronas NJ, Doppman JL, et al. Cushing syndrome: pituitary CT scanning. Radiology 1987;162:775.PubMedGoogle Scholar
  53. 51.
    Scheithauer BW, Kovacs KT, Randall RV, et al. Effects of estrogen on the human pituitary: a clinicopathologic study. Mayo Clin Proc. 1989;64:1077.PubMedGoogle Scholar
  54. 52.
    Schwezinger G, Warzok R. Hyperplasien und adénome der hypophyse im unselektierten sektionsgut. Zentralbi Allg Pathol 1982;126:495.Google Scholar
  55. 53.
    Schlechte J, Dolan K, Sherman B, et al. The natural history of untreated hyperprolactinemia; a prospective analysis. J Clin Endocrinol Metab. 1989;68:412.PubMedCrossRefGoogle Scholar
  56. 54.
    Sharara FI, Chrousos GP, Patronas NJ. Watchful waiting and craniopharyngioma. Ann Intern Med 1992;117:876.PubMedGoogle Scholar
  57. 55.
    Shomali ME, Katznelson L. Medical therapy for gonadotroph and thyrotroph tumors. Endocrinol Metab Clin North Am. 1999;28:XX..Google Scholar
  58. 56.
    Shubiger O, Haller D. Metastases to the pituitary-hypothalamic axis. An MR study of 7 symptomatic patients. Neuroradiology 1992;34:131.CrossRefGoogle Scholar
  59. 57.
    Siqueira MG, Guembarovski AL. Subclinical pituitary microadenomas. Surg Neurol. 1984;22:134.PubMedCrossRefGoogle Scholar
  60. 58.
    Sisam DA, Sheehan JP, Sheeler LR. The natural history of untreated microprolactinomas. Fertil Steril. 1987;48:67.PubMedGoogle Scholar
  61. 59.
    Sommers SC. Pituitary cell relations to body states. Lab Invest. 1959;8:588.PubMedGoogle Scholar
  62. 60.
    Soule SG, Jacobs HS. The evaluation and management of subclinical pituitary disease. Postgrad Med J. 1996;72:258.PubMedCrossRefGoogle Scholar
  63. 61.
    Susman W. Pituitary adenoma. Br Med J. 1933;2:1215.Google Scholar
  64. 62.
    Teramoto A, Hirakawa K, Sanno N, et al. Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 1994; 193:161.PubMedGoogle Scholar
  65. 63.
    Von Werder K. Pituitary enlargement. Clin Endocrinol. 1996;44:299.CrossRefGoogle Scholar
  66. 64.
    Webb SM, Ruscalleda J, Schwarzstein D, et al. Computerized tomography versus magnetic resonance imaging: a comparative study in hypothalamic-pituitary and parasellar pathology. Clin Endocrinol. 1992;36:459.CrossRefGoogle Scholar
  67. 65.
    Weiss MH, Teal J, Gott P, et al. Natural history of microprolactinomas: six-year follow-up. Neurosurgery 1983;2:180.CrossRefGoogle Scholar
  68. 66.
    Wolpert SM, Molitch ME, Goldman JA, et al. Size, shape and appearance of the normal female pituitary gland. Am J Neuroradiol. 1984;5:263.Google Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Mark E. Molitch
    • 1
  1. 1.Northwestern University Medical SchoolChicagoUSA

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