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Eur J Endocrinol. 2016 Jul;175(1):1-9. doi: 10.1530/EJE-16-0041. Epub 2016 Apr 1.

Analysis and natural history of pituitary incidentalomas.

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Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada
Division of Endocrinology and MetabolismDalhousie University, Halifax, Nova Scotia, Canada.
Division of Endocrinology and MetabolismWestern University, London, Ontario, Canada.
Department of MedicineTawam Hospital in affiliation with Johns Hopkins, Al Ain, UAE.
Cape Breton Regional HospitalSydney, Nova Scotia, Canada.
Division of NeurosurgeryDalhousie University, Halifax, Nova Scotia, Canada.



Pituitary incidentalomas (PI) are frequently found on brain imaging. Despite their high prevalence, little is known about their long-term natural history and there are limited guidelines on how to monitor them.


We conducted a retrospective study to compare epidemiological characteristics at presentation and the natural history of PI in population-based vs referral-based registries from two tertiary-care referral centers in Canada.


A total of 328 patients with PI were included, of whom 73% had pituitary adenomas (PA) and 27% had non-pituitary sellar masses. The commonest indications for imaging were headache (28%), dizziness (12%) and stroke/transient ischemic attack (TIA) (9%). There was a slight female preponderance (52%) with a median age of 55 years at diagnosis; 71% presented as macroadenomas (>10mm). Of PA, 25% were functioning tumors and at presentation 36% of patients had evidence of secondary hormonal deficiency (SHD). Of the total cohort, 68% were treated medically or conservatively whereas 32% required surgery. Most tumors (87% in non-surgery and 68% in post-surgery group) remained stable during follow-up. Similarly, 84% of patients in the non-surgery and 73% in the surgery group did not develop additional SHD during follow-up. The diagnosis of non-functioning adenoma was a risk factor for tumor enlargement and a change in SHD status was associated with a change in tumor size.


Our data suggest that most PI seen in tertiary-care referral centers present as macroadenomas and may frequently be functional, often requiring medical or surgical intervention.

[Indexed for MEDLINE]

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