Chevy Chase, MD—Today, The Endocrine Society released a
new Clinical Practice Guideline (CPG) for the evaluation and
treatment of pituitary incidentalomas. The CPG is published in the
April 2011 issue of the Journal of Clinical Endocrinology &
Metabolism (JCEM), a publication of The Endocrine Society.
A pituitary incidentaloma is a tumor or lesion on or near the
pituitary gland. It is found when a person has an imaging test for
an unrelated reason. Doctors call this an “incidental” finding,
meaning by chance—thus, the name incidentaloma. This surprise
finding is not uncommon. In studies of adults who had head imaging
with MRI or CT scans for reasons other than pituitary disease,
small incidentalomas were present in up to 20 percent of
patients.
“Fortunately, incidentalomas are almost always benign and
usually do not need surgery,” said Pamela Freda, MD, of the
Columbia College of Physicians & Surgeons in New York and chair
of the task force that authored the CPG. “This new Clinical
Practice Guideline makes recommendations for evaluating and
treating a patient with a pituitary incidentaloma, and indicating
when surgical therapy may be necessary.”
Recommendations from the CPG include:
- A complete history and physical examination, including a visual
field examination if the lesion is touching the optic nerves, for
patients with a pituitary incidentaloma; - Clinical assessments, neuro-imaging and visual field
examinations for patients with pituitary incidentalomas not meeting
criteria for surgical removal; and - Surgery for patients with pituitary incidentaloma if the tumor
is leading to visual abnormalities, stroke-like damage to the
pituitary gland (also known as a pituitary apoplexy) or if the
tumor itself is producing excess hormones other than
prolactin.
The Hormone Foundation, the patient education affiliate of The
Endocrine Society, has published a companion patient guide to this
CPG. The patient guide, which can be found online at
www.hormone.org/Resources/upload/Pituitary-Incidentaloma-Web.pdf,
defines the different types of pituitary incidentalomas, lists the
condition’s symptoms and explains how incidentalomas are treated
and when surgery may be needed.
Other members of The Endocrine Society task force that developed
this CPG include: Albert Beckers of CHU de Liège in Belgium;
Laurence Katznelson of Stanford University in Calif.; Mark Molitch
of the Northwestern Feinberg School of Medicine in Chicago, Ill.;
Victor Montori of Mayo Clinic Rochester in Minn.; Kalmon Post of
Mount Sinai Medical Center in New York, N.Y.; and Mary Lee Vance of
the University of Virginia Health Science Center in
Charlottesville.
The Society established the Clinical Practice Guideline (CPG)
Program to provide endocrinologists and other clinicians with
evidence-based recommendations in the diagnosis and treatment of
endocrine-related conditions. Each CPG is created by a task force
of topic-related experts in the field. Task forces rely on
scientific reviews of the literature in the development of CPG
recommendations. The Endocrine Society does not solicit or accept
corporate support for its CPGs. All CPGs are supported entirely by
Society funds.
