Therapeutic strategy for incidentally found pituitary tumors ("pituitary incidentalomas")

To evaluate therapeutic strategy for incidentally found pituitary tumors ("pituitary incidentalomas"), we analyzed the results of magnetic resonance imaging findings and of ophthalmological and endocrinological studies in 28 cases with long-term follow-up (Hardy's classification: Grade A, 24 cases; Grade B, 4 cases).

Only cases of nonfunctioning macroincidentaloma were analyzed in this study. Cases with ophthalmological and/or endocrinological dysfunction revealed by the first evaluation, even without subjective manifestations, were excluded from the category. Incidentally found functioning tumors were also excluded.

The follow-up period ranged from 6 months to 10 years (mean, 5.6 yr). Magnetic resonance imaging and ophthalmological and endocrinological studies, including provocation tests, were conducted once per year. No surgical treatment was required in any case of Grade A tumors and in two cases of Grade B tumors because of no changes revealed by these studies. Transsphenoidal surgery was performed in the remaining two cases of Grade B tumors because of pituitary apoplexy. The second case was one of head injury-induced apoplexy. There were no deficits after surgery. The MIB-1 index did not differ in operated incidentaloma and symptomatic pituitary tumors.

Unless ophthalmological and endocrinological dysfunction is noted, surgical treatment is not required for Grade A pituitary incidentalomas. It is not too late to remove the tumor surgically, even after some dysfunction develops. A patient having a tumor larger than Grade A can still be managed conservatively; however, the patient should be carefully informed of the possibility of pituitary apoplexy, and emergency transsphenoidal surgery is indicated if apoplexy occurs.