[Hypophyseal incidentaloma is a common finding requiring investigation. The question is: surgery, medication or...

The advent of new radiological methods such as CT (computerised tomography) and MRI (magnetic resonance imaging) has resulted in the detection of increasing numbers of anatomical changes in the pituitary. When discovered in patients without evidence of pituitary disease, they are called pituitary incidentalomas. They defy classification on a radiological basis. Micro-incidentalomas (< 10 mm in diameter) do not usually cause pituitary insufficiency, but may be associated with low-grade overproduction of prolactin, growth hormone, or adrenocorticotropic hormone (which may be cyclic). Although micro-incidentalomas rarely increase in size, follow-up with CT or MRI is recommended after one, two and five years. Macro-incidentalomas (> or = 10 mm in diameter) should initially be investigated with respect to possible visual field defects and any evidence of pituitary insufficiency, particularly hypogonadism. In some instances, macro-incidentalomas increase in size and require monitoring with MRI or CT at closer intervals, i.e., after six months, and then after one and two years, and every other year thereafter.