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Related Experiment Videos

Pituitary incidentalomas.

D C Aron1, T A Howlett

  • 1Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. david.aron@med.va.gov

Endocrinology and Metabolism Clinics of North America
|March 25, 2000
PubMed
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Hormonal screening for incidental pituitary masses is debated. While some risk exists, widespread testing may cause harm due to false positives and the cascade effect, necessitating careful clinical judgment.

Area of Science:

  • Endocrinology
  • Diagnostic Imaging
  • Medical Decision Making

Background:

  • The optimal hormonal screening strategy for incidentally discovered pituitary masses remains unclear.
  • Incidentalomas carry a slight risk of morbidity and mortality, suggesting a benefit for early diagnosis in select cases.
  • Clinically diagnosed hormone-secreting pituitary tumors are significantly less common than incidentalomas.

Purpose of the Study:

  • To review the endocrinologic literature regarding hormonal screening for incidental pituitary masses.
  • To evaluate the risks and benefits of hormonal screening in patients with incidentally discovered pituitary lesions.
  • To provide recommendations for minimizing untoward effects of diagnostic cascades.

Main Methods:

  • Review of the endocrinologic literature.

Related Experiment Videos

  • Analysis of prevalence data for hormone-secreting pituitary tumors versus incidentalomas.
  • Discussion of diagnostic test limitations and the 'cascade effect' of unnecessary testing.

    • Main Results:

    • Accurately identifying the small percentage of patients with incidentalomas at increased risk is challenging.
    • Effective hormonal screening requires a high pretest probability to limit false positives.
    • Unnecessary testing and treatment carry inherent risks, including financial costs and potential harm from false-positive results.

    Conclusions:

    • Physicians must balance the low probability of significant disease with the risks of extensive testing.
    • Clinical judgment, informed by prevalence data and patient condition, should guide screening decisions.
    • Further studies are needed to clarify the clinical utility of hormonal screening for incidental pituitary findings.