Pituitary incidentalomas: application of an evidence-based approach at the individual patient and population levels

Abstract

With the widespread use of imaging techniques, incidental discovery of clinically unsuspected pituitary adenomas is increasing in frequency and will increase further. The Endocrine Society Task Force on Pituitary Incidentalomas has developed practice guidelines which reflect the best available evidence combined with the opinions of experts in pituitary diseases. For incidental macroadenomas, evidence supporting comprehensive evaluation (for hyperfunction, hypopituitarism and anatomy) and management (whether surgical or careful follow-up) is strong. By contrast, evidence supporting approaches to microadenomas without clinical suggestion of hormonal hypersecretion are relatively weak and practice varies. Developing more evidence will require approaches other than randomized controlled trials, such as comparative effectiveness studies. Incidentalomas represent part of a larger societal issue, that being overdiagnosis and its consequences.

Keywords::

• clinical decision-making
• healthcare technology
• incidentaloma
• pituitary adenoma
• pituitary tumor

Acknowledgement

The author wishes to thank D Abdelmannan for the assistance in the literature review.

Financial & competing interests disclosure

DC Aron serves on and receives funding from the Department of Veterans Affairs/Veterans Health Administration Office of Specialty Care, Office of Nursing Services and Office of Research-Health Services Research & Development. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Endocrine Society Guidelines represent a good first step in informing evidence-based practice.

• • Pituitary incidentalomas are common and their course is usually benign.

• • Approaches to evaluation and management include testing versus expectant management with decision-making best guided by size, location relative to the optic chiasm and function of the tumor.

• • For incidental macroadenomas, evidence supporting comprehensive evaluation (for hyperfunction, hypopituitarism and anatomy) and management (whether surgical or careful follow-up) is strong.

• • Evidence supporting approaches to microadenomas without clinical suggestion of hormonal hypersecretion are relatively weak and practice varies.

• • Developing more evidence will require approaches other than randomized controlled trials, such as comparative effectiveness studies.

• • Incidentalomas represent part of a societal issue, that being overdiagnosis and its consequences.

Notes