Clinical Practice Guideline

Pituitary Incidentaloma

April 19, 2011

Full Guideline: Pituitary Incidentaloma: An Endocrine Society Clinical Practice Guideline
JCEM April 2011
Pamela U. Freda, Albert M. Beckers, Laurence Katznelson, Mark E. Molitch, Victor M. Montori, Kalmon D. Post, Mary Lee Vance

Objective:

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

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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