Retrospective multicentric study of pituitary incidentalomas.
Previously unsuspected pituitary tumors (incidentalomas) were analyzed in autopsies (4.8-27%) and magnetic resonance imaging (MRI) (10-37%), most of them being micro-pituitary incidentalomas (PI). However, patients with PIs sometimes had macroadenomas which may relate to previously unsuspected neurological and/or endocrine abnormalities. This study aims to establish the incidence of macro- vs. micro-PIs, the need for medical and/or surgical treatment and the neurological and endocrine dysfunction in a retrospective evaluation of patients with PIs studied over six years (1994-2000). Thirty-eight of 46 patients with PIs (22 males), aged 16-77, were followed for a mean of 3.2 years. Initial hormonal testing, ophthalmologic evaluation and MRI were repeated during follow-up. Twenty-nine (63%) of 46 patients had macro-PIs and 17 (17%) micro-PIs. Twenty-three males (75%) had macro-PIs, 10 (34.5%) with visual field defects. Consultations leading to PI diagnosis were chronic headache (28%), cranial trauma (15.3%), sinusitis (13%) and stroke (13%). Partial deficiencies of the anterior pituitary function were confirmed in 19 PIs (41.3%), with secondary hypogonadism prevailing (30%). Seven PIs (15%) were prolactinomas treated with dopamine agonists. Seventeen PIs (37%) underwent surgery. Immunohistochemical analysis showed gonadotrophinomas (30%), plurihormonal non-secreting adenomas (40%), and pituitary adenomas not reacting to any of the anterior pituitary hormone antibodies (30%). One operated macro-PI was a craniopharyngioma. Our data show a high percentage of PIs are macro-incidentalomas against expectations from necropsy and imaging studies. Most macro-PIs are found in males and are clinically non-functioning adenomas, 37% requiring surgery and hormonal substitution.
Day
Patricia Fainstein
PF
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina. patricia.fainstein@hospitalitaliano.org.ar.|, Lezica 3954, 1202, Buenos Aires, Argentina. patricia.fainstein@hospitalitaliano.org.ar.
Guitelman
Mirtha
M
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Artese
Rosa
R
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Fiszledjer
León
L
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Chervin
Alberto
A
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Vitale
Nicolás Marcelo
NM
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Stalldecker
Graciela
G
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
De Miguel
Valeria
V
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Cornaló
Dora
D
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Alfieri
Analía
A
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Susana
María
M
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
Gil
Mallea
M
Neuroendocrinology Department of the Argentine Society of Endocrinology and Metabolism, Buenos Aires (Departamento de Neuroendocrinología de la Sociedad Argentina de Endocrinología y Metabolismo, Buenos Aires), Díaz Velez, Buenos Aires, 1200, Argentina.
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D015175:Prolactinoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies