Management of pituitary incidentaloma

Pituitary incidentalomas (PIs) represent a modern clinical entity increasingly recognized due to advances and easier accessibility to imaging techniques. By definition, PIs should be detected during brain imaging performed for investigation of a non-pituitary disease. Although anatomic variations, technical artefacts or pituitary hyperplasia might also be interpreted as PIs, the most relevant incidentally detected lesions are those that fulfill radiological criteria for a pituitary adenoma in asymptomatic patients or in the presence of subclinical diseases. The natural history of PIs is not fully determined, but there is a wealth of evidence indicating that most microincidentalomas (lesions < 10 mm) have a benign course, whereas macroincidentalomas (≥10 mm) deserve more attention due to an increased risk for hormone abnormalities and mass effects. This concept is important to keep in mind for an optimal diagnostic and therapeutic management of PIs that avoids harmful iatrogenesis and unnecessary health care costs.