Guidelines Issued for Pituitary Incidentaloma Treatment

Surgery recommended for visual abnormalities, pituitary apoplexy, or non-prolactin secretion

MONDAY, April 18 (HealthDay News) -- Treatment options for patients with pituitary incidentaloma should be decided after a complete history, physical examination, and laboratory screening, and, in certain cases, visual examination, according to the new Clinical Practice Guideline (CPG) published in the April issue of the Journal of Clinical Endocrinology & Metabolism.

Pamela U. Freda, M.D., from the Columbia College of Physicians & Surgeons in New York City, and colleagues reviewed available evidence and formulated practice guidelines for endocrine evaluation and treatment of pituitary incidentalomas.

The authors of the CPG recommend that patients with a pituitary incidentaloma should undergo a complete history, physical examination, and laboratory screening for hormone hypersecretion and hypopituitarism, and if the lesion abuts the optic nerves or chiasm, a visual field examination, as well. After these initial evaluations, patients who are not considered eligible for surgical removal should be followed up with clinical assessments, magnetic resonance imaging (six months for macroincidentaloma and a year for a microincidentaloma), and visual field examinations and endocrine testing for macroincidentalomas at six months and yearly thereafter. Patients should be referred for surgery if they have a visual field deficit; visual abnormalities, including ophthalmoplegia or neurologic compromise caused by tumor compression; lesion abutting the optic nerves or chiasm; pituitary apoplexy with visual disturbance; or if the incidentaloma secretes a hormone other than prolactin.

"This new CPG makes recommendations for evaluating and treating a patient with a pituitary incidentaloma, and indicating when surgical therapy may be necessary," Freda said in a statement.

All of the study authors disclosed financial relationships with the pharmaceutical industry.

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