title: Pituitary incidentaloma: an endocrine society clinical practice guideline.
abstract: OBJECTIVE
  The aim was to formulate practice guidelines for endocrine evaluation and treatment of pituitary incidentalomas.
  
  
  METHODS
  Consensus was guided by systematic reviews of evidence and discussions through a series of conference calls and e-mails and one in-person meeting.
  
  
  CONCLUSIONS
  We recommend that patients with a pituitary incidentaloma undergo a complete history and physical examination, laboratory evaluations screening for hormone hypersecretion and for hypopituitarism, and a visual field examination if the lesion abuts the optic nerves or chiasm. We recommend that patients with incidentalomas not meeting criteria for surgical removal be followed with clinical assessments, neuroimaging (magnetic resonance imaging at 6 months for macroincidentalomas, 1 yr for a microincidentaloma, and thereafter progressively less frequently if unchanged in size), visual field examinations for incidentalomas that abut or compress the optic nerve and chiasm (6 months and yearly), and endocrine testing for macroincidentalomas (6 months and yearly) after the initial evaluations. We recommend that patients with a pituitary incidentaloma be referred for surgery if they have a visual field deficit; signs of compression by the tumor leading to other visual abnormalities, such as ophthalmoplegia, or neurological compromise due to compression by the lesion; a lesion abutting the optic nerves or chiasm; pituitary apoplexy with visual disturbance; or if the incidentaloma is a hypersecreting tumor other than a prolactinoma.
authors.affiliation: Columbia College of Physicians & Surgeons, New York, New York 10032, USA.
authors.forename: Pamela U
authors.initials: PU
authors.lastname: Freda
authors.forename: Albert M
authors.initials: AM
authors.lastname: Beckers
authors.forename: Laurence
authors.initials: L
authors.lastname: Katznelson
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Kalmon D
authors.initials: KD
authors.lastname: Post
authors.forename: Mary Lee
authors.initials: ML
authors.lastname: Vance
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000628:therapy*; D000465:Algorithms; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D013507:Endocrine Surgical Procedures / Q000706:statistics & numerical data; D004704:Endocrinology / Q000458:organization & administration; D055317:Evidence-Based Practice; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012955:Societies, Medical