High-resolution computed tomography in pituitary microadenoma: is seeing believing?

Area of Science:

• Endocrinology
• Neurosurgery
• Radiology

Background:

• Pituitary microadenomas can cause hyperprolactinaemia and hypercortisolaemia.
• The diagnostic accuracy of high-resolution computed tomography (CT) for identifying these tumors remains controversial.

Purpose of the Study:

• To evaluate the reliability of high-resolution CT in detecting functioning pituitary microadenomas.
• To compare CT findings with surgical and histological results in patients with hormonal imbalances.

Main Methods:

• 34 patients with hyperprolactinaemia and/or hypercortisolaemia underwent high-resolution CT of the pituitary gland.
• Surgical exploration (trans-sphenoidal) and histological examination were performed for comparison.

Main Results:

• CT identified 28 abnormalities, but only 20 were confirmed as tumors surgically.
• Nine tumors were found during surgery in areas deemed radiologically normal by CT.
• CT correlated well with surgical findings only for tumors larger than 6 mm.

Conclusions:

• High-resolution CT interpretation for pituitary microadenomas requires caution due to limited reliability.
• CT is not recommended for routine assessment of hyperprolactinaemia or Cushing's syndrome.
• CT should be reserved for specific cases, including pre-surgical evaluation or extreme hormone hypersecretion.